=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407730740
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PHILLIP MATTHEW MAHONEY PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2025
-----------------------------------------------------
Last Update Date | 07/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1625 3RD AVE
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25755-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-696-3641
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33 HIGH ST
-----------------------------------------------------
City | WHEELERSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45694-8562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-400-1693
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SLP-2665
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------