MEDICARE: COLLEEN MAHONEY

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	390200000X	Student in an Organized Health Care Education/Training Program	0000	KY

General Provider Information

NPI Number	:	1942025101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN MAHONEY

Provider Business Mailing Address
First Line	:	2017 EASTERN PKWY APT 4
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-1426
Country	:	US
Telephone Number	:	570-244-1525
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 S PRESTON ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-1702
Country	:	US
Telephone Number	:	502-852-5193
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2024
Last Update Date	:	11/21/2024

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Directions to “ COLLEEN MAHONEY ” Practice Location

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