Provider Demographics
NPI:1720204571
Name:MCMAHEN, KASEY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:MCMAHEN
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 1:413 WILBURN HTS
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72941-7613
Mailing Address - Country:US
Mailing Address - Phone:479-478-0191
Mailing Address - Fax:
Practice Address - Street 1:7701 ZERO ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6644
Practice Address - Country:US
Practice Address - Phone:479-478-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1938235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist