Healthcare Provider Details

I. General information

NPI: 1447992920
Provider Name (Legal Business Name): MICHELE COLLEEN MCMAHON MA/CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12777 VILLAGE CIRCLE DR
SAINT LOUIS MO
63127-1757
US

IV. Provider business mailing address

3829 OLDE MILL DR
BYRNES MILL MO
63051-1239
US

V. Phone/Fax

Practice location:
  • Phone: 866-896-1347
  • Fax:
Mailing address:
  • Phone: 314-691-6922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: