Provider Demographics
NPI:1669798799
Name:MAHONEY, LORI ELIZABETH (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ELIZABETH
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ELIZABETH
Other - Last Name:FAVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:106 CHICKEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:KERSEY
Mailing Address - State:PA
Mailing Address - Zip Code:15846-9103
Mailing Address - Country:US
Mailing Address - Phone:814-885-6393
Mailing Address - Fax:
Practice Address - Street 1:763 JOHNSONBURG RD
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3417
Practice Address - Country:US
Practice Address - Phone:814-788-8136
Practice Address - Fax:814-788-8091
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL0057154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist