Provider Demographics
NPI:1376179820
Name:MCMAHAN, DAMIANA LEA (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:DAMIANA
Middle Name:LEA
Last Name:MCMAHAN
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 1:11511 ESCANCENA LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-6596
Mailing Address - Country:US
Mailing Address - Phone:956-279-3031
Mailing Address - Fax:
Practice Address - Street 1:12 INTER PARK BLVD
Practice Address - Street 2:#105
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216
Practice Address - Country:US
Practice Address - Phone:210-822-0475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104186235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist