Provider Demographics
NPI:1386690196
Name:MCMAHON, KATHLEEN (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:STANCLIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 MEDICAL PKWY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4911
Mailing Address - Country:US
Mailing Address - Phone:757-547-9714
Mailing Address - Fax:757-547-0725
Practice Address - Street 1:200 MEDICAL PKWY
Practice Address - Street 2:SUITE 303
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4911
Practice Address - Country:US
Practice Address - Phone:757-547-9714
Practice Address - Fax:757-547-0725
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001266231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist