Mallory Scrivner Welch
Individual provider Active NPI Speech-Language Pathologist · Bethalto, IL
NPI 1205256807 · NPPES record last updated Apr 22, 2014
Key facts
- NPI
- 1205256807
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 146.006103 (IL)
- Practice address
- 610 Texas Blvd
Bethalto, IL 62010-1754 - Phone
- (618) 377-7200
- NPI assigned
- Apr 22, 2014
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146.006103 | IL | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 146.006103 | IL | Yes |
Addresses
Primary practice location
610 Texas Blvd
Bethalto, IL 62010-1754
Mailing address
4254 Bassen Dr
Swansea, IL 62226-7910
Phone (618) 407-2427
Other names
- Mallory Scrivner Koontz
Other providers in Bethalto, IL
- Uptown Emergency Physicians LLP
- Vernon Andersen Inc
- Billie Vincent
- Walgreen Co
- Ashley Dawn Weant
- Alan Joseph Wickenhauser
- Keith Michael Williams
- Robin R Wzorek
All providers in Bethalto, IL · Speech-Language Pathologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 22, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.