Active NPI
Dawn A. Mallard, MA CCC-SLP
- Speech-Language Pathologist
- Ponte Vedra Beach, FL
National Provider Identifier
1013926385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SA5628
- Practice address
- 880 A1A N
Ste 18a
Ponte Vedra Beach, FL 32082-3220 - Phone
- (904) 778-7501
- Fax
- (904) 778-7504
- NPI assigned
- Aug 5, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SA5628 | FL | Primary |
Addresses
Primary practice location
880 A1A N
Ste 18a
Ponte Vedra Beach, FL 32082-3220
Mailing address
PO Box 48116
Jacksonville, FL 32247-8116
Phone (904) 725-1657
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SA5628 | FL | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| PVPT, Inc. | Past | Accepting new patients | |
| Ponte Vedra Physical Therapy, Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Rehabilitation Clinic/Center
- Ponte Vedra Beach, FL
- NPI 1043246580
-
- Rehabilitation Clinic/Center
- Ponte Vedra Beach, FL
- NPI 1417992231
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013926385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 48116",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322478116",
"telephone_number": "904-725-1657",
"fax_number": "904-725-7247"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "880 A1A N",
"address_2": "STE 18A",
"city": "PONTE VEDRA BEACH",
"state": "FL",
"postal_code": "320823220",
"telephone_number": "904-778-7501",
"fax_number": "904-778-7504"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLARD",
"first_name": "DAWN",
"middle_name": "A.",
"credential": "MA CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SA5628",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ponte Vedra Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.