Provider Demographics
NPI:1508998949
Name:STIVASON, DAMON ALLEN (BC-HIS, ACA)
Entity Type:Individual
Prefix:MR
First Name:DAMON
Middle Name:ALLEN
Last Name:STIVASON
Suffix:
Gender:M
Credentials:BC-HIS, ACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 WEST BEAU STREET
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301
Mailing Address - Country:US
Mailing Address - Phone:724-225-6990
Mailing Address - Fax:724-225-6992
Practice Address - Street 1:150 W BEAU ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4425
Practice Address - Country:US
Practice Address - Phone:724-225-6990
Practice Address - Fax:724-225-6992
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPAFO2503237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist