Individual provider Active NPI

Mallory Ellen Amo, MA-CCC-SLP

  • Speech-Language Pathologist
  • Rapid City, SD
National Provider Identifier
1619642725
Registry record updated Aug 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
982-PORV Issued in SD
Practice address
7110 Jordan Dr
Rapid City, SD 57702-8738
Phone
(605) 791-7400
NPI assigned
Aug 11, 2021
Last updated
Aug 11, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 982-PORV SD Primary

Addresses

Primary practice location

7110 Jordan Dr
Rapid City, SD 57702-8738

Mailing address

4820 Pierre St
Rapid City, SD 57702-1833
Phone (605) 593-6743

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241213002594 SD Practitioner - Qualified Speech Language Pathologist 4880120864 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dakota Speech and Swallow CenterGroup PAC ID 7214398239, 3 clinicians

Practice addresses (Care Compare)

6015 Mount Rushmore Rd
Suite 3
Rapid City, SD 57701-8984
Phone (605) 443-6164

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
982-PORVSDMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Dakota Speech and Swallow Center Speech-Language Pathologist CurrentSince Oct 12, 2024 Accepting new patients

Locations

6015 Mount Rushmore Rd
Ste 3
Rapid City, SD 57701
Phone (605) 443-6164

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1628640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628640000000",
    "number": "1619642725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4820 PIERRE ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577021833",
            "telephone_number": "605-593-6743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7110 JORDAN DR",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577028738",
            "telephone_number": "605-791-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMO",
        "first_name": "MALLORY",
        "middle_name": "ELLEN",
        "credential": "MA-CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-11",
        "last_updated": "2021-08-11",
        "certification_date": "2021-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "SD",
            "license": "982-PORV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rapid City, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.