Provider Demographics
NPI:1447420237
Name:MAHON, COLLEEN I (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:I
Last Name:MAHON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 WINDY RUN RD
Mailing Address - Street 2:
Mailing Address - City:TESLA
Mailing Address - State:WV
Mailing Address - Zip Code:26629-9503
Mailing Address - Country:US
Mailing Address - Phone:304-765-5202
Mailing Address - Fax:
Practice Address - Street 1:288 N HILL RD
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:WV
Practice Address - Zip Code:26601-1225
Practice Address - Country:US
Practice Address - Phone:304-765-5202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist