Mallorie Bryan Costner, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

5677 Issued in SC

Practice address

507 Huntington Road
Easley, SC 29642

Phone

(864) 918-2361

NPI assigned

Apr 11, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1302480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433376000000",
    "number": "1942590088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 HUNTINGTON ROAD",
            "city": "EASLEY",
            "state": "SC",
            "postal_code": "29642",
            "telephone_number": "864-918-2361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 HUNTINGTON ROAD",
            "city": "EASLEY",
            "state": "SC",
            "postal_code": "29642",
            "telephone_number": "864-918-2361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTNER",
        "first_name": "MALLORIE",
        "middle_name": "BRYAN",
        "name_prefix": "Mrs.",
        "credential": "SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-04-11",
        "last_updated": "2015-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "SC",
            "license": "5677",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ID",
            "license": "SLP - 2084",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Easley, SC
• Providers in Easley, SC by specialty
• Speech-Language Pathologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2015; 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.