Provider Demographics
NPI:1649303595
Name:MCMAHAN, AMY BROWN (MACCCSLP)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:BROWN
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7809 ZUBER RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-1689
Mailing Address - Country:US
Mailing Address - Phone:870-941-5152
Mailing Address - Fax:501-794-1729
Practice Address - Street 1:1389 LAFITE LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-9808
Practice Address - Country:US
Practice Address - Phone:870-941-5152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2308235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR2308OtherSTATE LICENSE #