Doctor Name: | MRS. MALLORY BOTELER DOUGHERTY |
NPI Number: | 1881982551 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S., CCC-SLP |
License Number: | 107640 |
Business Practice Address: | 921 Shiloh Rd #120 Tyler, TX - 757031431 |
Business Phone Number: | 9039392800 |
Business Fax Number: | |
Mailing Address: | 305 Ne Loop 820, Business Tower 1, Suite 200 HURST |
State: | TX |
Postal Code: | 760537209 |
Phone Number: | 8172928787 |
Fax Number: | 8177896849 |
NPI Enumeration Date: | 07/15/2011 |
NPI Last Update Date: | 08/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 107640 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
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 |