Provider Demographics
NPI:1043537269
Name:MAHANEY, TARA ALISON (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:ALISON
Last Name:MAHANEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7261 PEBBLE PL
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-9126
Mailing Address - Country:US
Mailing Address - Phone:517-925-8507
Mailing Address - Fax:
Practice Address - Street 1:420 S WAVERLY RD STE 5
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-3632
Practice Address - Country:US
Practice Address - Phone:517-925-8507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist