Mallory Robertson

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

201904 Issued in AR

Practice address

105 S Blair St
Springdale, AR 72764-4410

Phone

(479) 259-2339

NPI assigned

Jun 28, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mallory Mixon Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Kids Spot LLC

  • Physical Therapy Clinic/Center
  • Springdale, AR
  • NPI 1174845358

  Speech-Language Pathologist

  NPD (past)

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

{
    "created_epoch": "1656374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656374400000",
    "number": "1609508753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1522 CANAL ST",
            "city": "LOWELL",
            "state": "AR",
            "postal_code": "727456025",
            "telephone_number": "405-612-8730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 S BLAIR ST",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727644410",
            "telephone_number": "479-259-2339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "MALLORY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-28",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AR",
            "license": "201904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORY",
            "last_name": "MIXON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Charla Roberts, M.S.,CCC-SLP
• Emily Roberts, OTR
• Halee Fawne Roberts, LCSW
• Magen N Roberts
• Christine A Robertson, LCSW
• Randy Robertson
• Ashely Marie Robinson, MHPP
• Misty Dawn Robinson, RN
• Donna T. Rocha, M.D.
• Rocking Chair Inn

• Speech-Language Pathologist in Springdale, AR
• Providers in Springdale, AR by specialty
• Speech-Language Pathologist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2022; 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.