| Doctor Name: | MS. MALLORY SCRIVNER WELCH |
| NPI Number: | 1205256807 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 146.006103 |
| Business Practice Address: | 610 Texas Blvd Bethalto, IL - 620101754 |
| Business Phone Number: | 6183777200 |
| Business Fax Number: | |
| Mailing Address: | 4254 Bassen Dr, SWANSEA |
| State: | IL |
| Postal Code: | 622267910 |
| Phone Number: | 6184072427 |
| Fax Number: | |
| NPI Enumeration Date: | 04/22/2014 |
| NPI Last Update Date: | 04/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 146.006103 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |