Provider Demographics
NPI:1790180578
Name:MAHONEY, JENNY LYNN (MS SLP CCC)
Entity Type:Individual
Prefix:MISS
First Name:JENNY
Middle Name:LYNN
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:MS SLP CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 YOUMANS AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:53 YOUMANS AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTN
Practice Address - State:NJ
Practice Address - Zip Code:07882
Practice Address - Country:US
Practice Address - Phone:908-328-4084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00749400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist