Healthcare Provider Details

I. General information

NPI: 1306187638
Provider Name (Legal Business Name): STEPHANIE JO HOHOS-MAHONEY MS,CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 EAST 38 STREET
ERIE PA
16504
US

IV. Provider business mailing address

2323 EAST GRANDVIEW BOULAVARD
ERIE PA
16510-3947
US

V. Phone/Fax

Practice location:
  • Phone: 814-323-2398
  • Fax:
Mailing address:
  • Phone: 814-323-2398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL007521
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: