Provider Demographics
NPI:1750890547
Name:FALLON, DAVID A (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:FALLON
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 73RD ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55038-9619
Mailing Address - Country:US
Mailing Address - Phone:480-388-6719
Mailing Address - Fax:
Practice Address - Street 1:1919 73RD ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:MN
Practice Address - Zip Code:55038-9619
Practice Address - Country:US
Practice Address - Phone:480-388-6719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist