Provider Demographics
NPI:1104331321
Name:MCMAHON, ALEXIS MARY (SPEECH PATHOLOGIST)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MARY
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 EDMOND DR
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1523
Mailing Address - Country:US
Mailing Address - Phone:219-322-1415
Mailing Address - Fax:
Practice Address - Street 1:440 EDMOND DR
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1523
Practice Address - Country:US
Practice Address - Phone:219-322-1415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46003248A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist