Provider Demographics
NPI:1023731635
Name:DREWES, MALLORY LYNN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:LYNN
Last Name:DREWES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 W MAUMEE AVE
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-1930
Mailing Address - Country:US
Mailing Address - Phone:419-438-3826
Mailing Address - Fax:
Practice Address - Street 1:09876 WILLIAMS COUNTY ROAD 16
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506
Practice Address - Country:US
Practice Address - Phone:419-636-4508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID235Z00000X
235Z00000X
OHSP.15303235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist