Mallory Lynn Tillis, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP.0005885 Issued in CO

Practice address

6820 Southpoint Pkwy Ste 9
Jacksonville, FL 32216-6277

Phone

(039) 888-8754

NPI assigned

May 24, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Mallory Butler Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722124800000",
    "number": "1124519145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15701 E 1ST AVE STE 106",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800119037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6820 SOUTHPOINT PKWY STE 9",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322166277",
            "telephone_number": "039-888-8754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLIS",
        "first_name": "MALLORY",
        "middle_name": "LYNN",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-24",
        "last_updated": "2024-07-28",
        "certification_date": "2024-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA14700",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CO",
            "license": "SLP.0005885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORY",
            "last_name": "BUTLER",
            "credential": "SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Suwarna M Tilak, MD
• Grace Alexandra Tilbrook, AUD
• Ralph Thomas Tilbury, M.D.
• Beatrice Joy Tiller
• Bryce R Tiller, MD
• Tina Nannette Tillis, MD
• Tiffany Armika Tillman-Williams, RN
• Nancy T. Tillman, RN
• Noah Tillman, DC
• Shannon E Tillman, CMA

• Speech-Language Pathologist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.