Provider Demographics
NPI:1881375426
Name:MCMAHON, TERRY (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:
Other - Last Name:LUNDAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16160 AMETHYST KEY DR
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-4027
Mailing Address - Country:US
Mailing Address - Phone:813-390-7621
Mailing Address - Fax:
Practice Address - Street 1:602 VONDERBURG DR STE 201
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5900
Practice Address - Country:US
Practice Address - Phone:813-653-1149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1021235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist