Provider Demographics
NPI:1942600796
Name:MAHONEY, KATIE (AUD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:RUPERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1720 NICHOLASVILLE RD
Mailing Address - Street 2:STE 500
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1404
Mailing Address - Country:US
Mailing Address - Phone:859-278-1114
Mailing Address - Fax:859-277-0541
Practice Address - Street 1:1720 NICHOLASVILLE RD
Practice Address - Street 2:STE 500
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1404
Practice Address - Country:US
Practice Address - Phone:859-278-1114
Practice Address - Fax:859-277-0541
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSLPAUD00210170231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0169Medicare PIN