Provider Demographics
NPI:1386725141
Name:MCMAHON, JERRI A
Entity type:Individual
Prefix:
First Name:JERRI
Middle Name:A
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 CHESHIRE PKWY N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-4103
Mailing Address - Country:US
Mailing Address - Phone:763-268-4115
Mailing Address - Fax:763-268-4017
Practice Address - Street 1:5510 W BROADWAY AVE
Practice Address - Street 2:STE 113 C
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55428-3577
Practice Address - Country:US
Practice Address - Phone:763-533-5722
Practice Address - Fax:763-533-5654
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2009237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist