Provider Demographics
NPI:1689843609
Name:MAHONEY, ALLYSON (MS, CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:ALLYSON
Middle Name:
Last Name:MAHONEY
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 1:9 MAPLE TREE AVE
Mailing Address - Street 2:E3
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06906-2251
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9 MAPLE TREE AVE
Practice Address - Street 2:E3
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06906-2251
Practice Address - Country:US
Practice Address - Phone:203-644-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-23
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003350235Z00000X
NY26-0193915235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist