Provider Demographics
NPI:1447992920
Name:MCMAHON, MICHELE COLLEEN (MA/CCC-SLP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:COLLEEN
Last Name:MCMAHON
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 1:3829 OLDE MILL DR
Mailing Address - Street 2:
Mailing Address - City:BYRNES MILL
Mailing Address - State:MO
Mailing Address - Zip Code:63051-1239
Mailing Address - Country:US
Mailing Address - Phone:314-691-6922
Mailing Address - Fax:
Practice Address - Street 1:12777 VILLAGE CIRCLE DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1757
Practice Address - Country:US
Practice Address - Phone:866-896-1347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist