Mallison Fisher, MS,CCC-SLP

Individual provider Active NPI Speech-Language Pathologist · Madisonville, TX

NPI 1669112694 · NPPES record last updated Mar 29, 2022

Key facts

NPI
1669112694
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
116640 (TX)
Practice address
411 E Collard St
Madisonville, TX 77864-3306
Phone
(936) 348-2735
NPI assigned
Mar 29, 2022
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
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
116640TXMDSpeech-Language Pathologist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 116640 TX Yes

Addresses

Primary practice location

411 E Collard St
Madisonville, TX 77864-3306

Mailing address

4150 Pendleton Dr Apt 1024
Bryan, TX 77802-2628
Phone (704) 239-0328

Other practice location 1

2333 Manor Dr
Bryan, TX 77802-1907
Phone (979) 821-7300

Other providers in Madisonville, TX

All providers in Madisonville, TX · Speech-Language Pathologist in Texas

Sources for this page

Verify at the official NPI Registry.