Provider Demographics
NPI:1528395084
Name:MCMAHON, BRENDA KAYE (MS/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAYE
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 CPT AUGUSTUS MCCRAE TRL
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79118-6449
Mailing Address - Country:US
Mailing Address - Phone:806-584-6862
Mailing Address - Fax:
Practice Address - Street 1:15300 E AMARILLO BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79108-7572
Practice Address - Country:US
Practice Address - Phone:806-335-3547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104106235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist