Provider Demographics
NPI:1124423371
Name:GUERRA, MALLORY ANN (MA, CCC, SLP/L)
Entity type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:ANN
Last Name:GUERRA
Suffix:
Gender:F
Credentials:MA, CCC, SLP/L
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:ANN
Other - Last Name:DIBERARDINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 WENDTWORTH COURT
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086
Mailing Address - Country:US
Mailing Address - Phone:716-361-4696
Mailing Address - Fax:
Practice Address - Street 1:1085 EGGERT ROAD, CHC LEARNING CENTER,
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-831-8422
Practice Address - Fax:716-831-8428
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024154-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist