Mallory Breanne Libbert, M.S., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

22006418A Issued in IN

Practice address

3150 Saint Charles St
Jasper, IN 47546-1858

Phone

(812) 634-6570

Fax

(812) 634-7919

NPI assigned

Nov 21, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Specialty

Qualified Speech Language Pathologist

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Legacy Therapy and Rehabilitation LLCGroup PAC ID 8325421472, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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.

• Legacy Therapy and Rehabilitation LLC

  • Occupational Therapist
  • Jasper, IN
  • NPI 1023743614

  Speech-Language Pathologist

  Medicare reassignment Care Compare group NPD
• JLR Family Practice, PC

  • Family Medicine Physician
  • Jasper, IN
  • NPI 1710185319
  NPD (past)

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

{
    "created_epoch": "1668988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668988800000",
    "number": "1619686391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2131 W 5TH AVE",
            "city": "JASPER",
            "state": "IN",
            "postal_code": "475469720",
            "telephone_number": "812-827-1062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3150 SAINT CHARLES ST",
            "city": "JASPER",
            "state": "IN",
            "postal_code": "475461858",
            "telephone_number": "812-634-6570",
            "fax_number": "812-634-7919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIBBERT",
        "first_name": "MALLORY",
        "middle_name": "BREANNE",
        "name_prefix": "Mrs.",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-11-21",
        "last_updated": "2022-11-21",
        "certification_date": "2022-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IN",
            "license": "22006418A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William E Lehmkuhler, MD
• Yvonne Lehr
• Emily Leinenbach, NP
• Brandy Lemen
• Joshua C. Leonard, MD
• Lifespring Inc.
• Lifespring, Inc
• Lifespring, Inc
• Lighthouse Wellness & Recovery LLC
• Melanie Kay Lindauer, OTR/L

• Speech-Language Pathologist in Jasper, IN
• Providers in Jasper, IN by specialty
• Speech-Language Pathologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2022; 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.