Healthcare Provider Details

I. General information

NPI: 1356714554
Provider Name (Legal Business Name): MARIE A MAHONEY AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIE A HOLBROOK AUD

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13340 HIGHLAND HILLS DR STE 212
ALEDO TX
76008-2000
US

IV. Provider business mailing address

PO BOX 733784
DALLAS TX
75373-3784
US

V. Phone/Fax

Practice location:
  • Phone: 682-885-6850
  • Fax: 682-885-6799
Mailing address:
  • Phone: 682-885-6483
  • Fax: 682-303-7132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number80811
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number80811
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: