Healthcare Provider Details

I. General information

NPI: 1679061931
Provider Name (Legal Business Name): COLLEEN MARY MCMAHON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6950 NE 14TH ST
ANKENY IA
50023-8903
US

IV. Provider business mailing address

6950 NE 14TH ST
ANKENY IA
50023-8903
US

V. Phone/Fax

Practice location:
  • Phone: 440-221-0783
  • Fax:
Mailing address:
  • Phone: 440-221-0781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number133541
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number07693
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: