Provider Demographics
NPI:1356954754
Name:LEMMON, MAKENNA (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MAKENNA
Middle Name:
Last Name:LEMMON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MAKENNA
Other - Middle Name:
Other - Last Name:TRACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:81 NOGOSO CIR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:OH
Mailing Address - Zip Code:45431-1532
Mailing Address - Country:US
Mailing Address - Phone:937-620-8510
Mailing Address - Fax:
Practice Address - Street 1:110 COMSTOCK ST
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:OH
Practice Address - Zip Code:45327-1006
Practice Address - Country:US
Practice Address - Phone:937-855-4203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.20201376-SP235Z00000X
OHSP.14486235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist