Mallory B Staggs, SLP-CCC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

140617 Issued in KY

Practice address

2388 Willow Lenoxburg Rd
Brooksville, KY 41004-8514

Phone

(606) 782-5435

NPI assigned

May 28, 2021

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

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.

• Up Up and Play LLC

  • Early Intervention Provider Agency
  • Cynthiana, KY
  • NPI 1982397113
  NPD Authorized official

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

{
    "created_epoch": "1622160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622160000000",
    "number": "1821664087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2388 WILLOW LENOXBURG RD",
            "city": "BROOKSVILLE",
            "state": "KY",
            "postal_code": "410048514",
            "telephone_number": "606-782-5435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2388 WILLOW LENOXBURG RD",
            "city": "BROOKSVILLE",
            "state": "KY",
            "postal_code": "410048514",
            "telephone_number": "606-782-5435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAGGS",
        "first_name": "MALLORY",
        "middle_name": "B",
        "credential": "SLP-CCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-28",
        "last_updated": "2021-05-28",
        "certification_date": "2021-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "KY",
            "license": "140617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Marion Joines, DMD
• Lewis County Primary Care Center, Inc.
• Spencer Magee
• Gary L. McCord, D.M.D.
• Kelsey Prater
• Lane Stephenson, LCSW
• Donna Teegarden, RN CDE MLDE
• Ashley Marie Tucker, FNP-BC
• Shelby Woods, B.H.S., M.S.

• Speech-Language Pathologist in Brooksville, KY
• Providers in Brooksville, KY by specialty
• Speech-Language Pathologist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2021; 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.