MEDICARE: TARA MAHANEY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1700223286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARA MAHANEY, LLC

Provider Business Mailing Address
First Line	:	616 S CREYTS RD STE B
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-8269
Country	:	US
Telephone Number	:	517-282-2281
Fax Number	:

Provider Business Practice Location Address
First Line	:	616 S CREYTS RD STE B
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-8269
Country	:	US
Telephone Number	:	517-282-2281
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. TARA MAHANEY
Credential	:
Telephone Number	:	517-282-2281

Provider Enumeration Date	:	05/24/2013
Last Update Date	:	01/22/2025

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Directions to “TARA MAHANEY, LLC ” Practice Location

Language	Start Address	Practice Location

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