Provider Demographics
NPI:1407300924
Name:MCMAHAN, KERRY
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 CHERRY AVE
Mailing Address - Street 2:APT 109
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-2751
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4950 CHERRY AVE
Practice Address - Street 2:APT 109
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-2751
Practice Address - Country:US
Practice Address - Phone:714-788-4230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23234235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist