Provider Demographics
NPI:1982001673
Name:MCMAKEN, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MCMAKEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3275 LONG COVE CT
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-8688
Mailing Address - Country:US
Mailing Address - Phone:614-531-5540
Mailing Address - Fax:
Practice Address - Street 1:525 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:OH
Practice Address - Zip Code:43025-9702
Practice Address - Country:US
Practice Address - Phone:740-928-5878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.10939235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist