Provider Demographics
NPI:1699327551
Name:CONDIT, MICHAEL M (SLP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:CONDIT
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 1:11012 HARRISON WAY
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:KY
Mailing Address - Zip Code:41094-9600
Mailing Address - Country:US
Mailing Address - Phone:513-432-7958
Mailing Address - Fax:
Practice Address - Street 1:2008 TIMBER LN
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-4501
Practice Address - Country:US
Practice Address - Phone:937-278-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.13928235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0406425Medicaid
OHAB7360731OtherMEDICARE PIN