Provider Demographics
NPI:1679090583
Name:MAHONEY, SUSAN ANN (MA CCC-SLP/L)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ANN
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:MA CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 W KENSINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1111
Mailing Address - Country:US
Mailing Address - Phone:847-463-8142
Mailing Address - Fax:
Practice Address - Street 1:799 W KENSINGTON RD
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-1111
Practice Address - Country:US
Practice Address - Phone:847-463-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.000536235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist