Provider Demographics
NPI:1871216598
Name:BLAKE-MAHON, MAURA ANN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:ANN
Last Name:BLAKE-MAHON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26007 BYRON DR
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-1913
Mailing Address - Country:US
Mailing Address - Phone:440-829-6356
Mailing Address - Fax:
Practice Address - Street 1:34050 GLEN DR
Practice Address - Street 2:
Practice Address - City:EASTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44095-2604
Practice Address - Country:US
Practice Address - Phone:440-283-4375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.14827235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist