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NPI Code Detail

MEDICARE: ALEXANDRIA MAHONEY

MEDICARE: ALEXANDRIA MAHONEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1962208504
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDRIA MAHONEY
Provider Business Mailing Address
First Line : 5505 W ROLLING HILLS DR
Second Line :
City : BRIDGEPORT
State : MI
Zip : 48722-9674
Country : US
Telephone Number : 989-891-9800
Fax Number :
Provider Business Practice Location Address
First Line : 5505 W ROLLING HILLS DR
Second Line :
City : BRIDGEPORT
State : MI
Zip : 48722-9674
Country : US
Telephone Number : 989-891-9800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2025
Last Update Date : 02/24/2025

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Directions to “ ALEXANDRIA MAHONEY ” Practice Location

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