Provider Demographics
NPI:1275269375
Name:MACON, DAMIEN J (SLP)
Entity Type:Individual
Prefix:MR
First Name:DAMIEN
Middle Name:J
Last Name:MACON
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10045 BALTIMORE NATIONAL PIKE UNIT A7 #679
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042
Mailing Address - Country:US
Mailing Address - Phone:813-244-7386
Mailing Address - Fax:
Practice Address - Street 1:10320 SWIFT STREAM PL APT 203
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-4894
Practice Address - Country:US
Practice Address - Phone:813-244-7386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02397L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist