Provider Demographics
NPI:1255857033
Name:MACKE, DEVAN E (MA, CFY/SLP)
Entity Type:Individual
Prefix:MS
First Name:DEVAN
Middle Name:E
Last Name:MACKE
Suffix:
Gender:F
Credentials:MA, CFY/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1879 US 52
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:OH
Mailing Address - Zip Code:45153-9676
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2400 CLERMONT CENTER DR
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1990
Practice Address - Country:US
Practice Address - Phone:513-735-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.12587235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist