Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mrs. Mallory Breanne Libbert, MS, CCC-SLP

Individual provider Speech-Language Pathologist · NPI 1619686391

Mrs. Mallory Breanne Libbert, MS, CCC-SLP is a Qualified Speech Language Pathologist in Jasper, Indiana. Qualified in 2015, 11 years ago. Practices with Legacy Therapy and Rehabilitation LLC, a 5-clinician group and accepts Medicare assignment. Licensed in Indiana.

Years since qualifying
11
Licensed in
IN
In the registry since
2022
What do these letters mean?
MS — Master of Science
A graduate science degree.
CCC-SLP — Certificate of Clinical Competence in Speech-Language Pathology
A speech-language pathologist certified by ASHA.

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Practice location Address checks out

3150 Saint Charles St
Jasper, IN 47546-1858
Phone: (812) 634-6570
Fax: (812) 634-7919
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Speech-Language Pathologist (primary) Taxonomy 235Z00000X · Licence 22006418A (IN)

Record details

NPI number1619686391
Entity typeIndividual (Type 1)
GenderFemale
Credentials MS , CCC-SLP
Sole proprietorYes
NPI enumeratedNovember 21, 2022
Last updated in NPPESNovember 21, 2022
Certification dateNovember 21, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyQUALIFIED SPEECH LANGUAGE PATHOLOGIST
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Legacy Therapy And Rehabilitation Llc — 5 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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