Healthcare Provider Details

I. General information

NPI: 1316856826
Provider Name (Legal Business Name): FALLON MACKENZIE SPITTEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6315 FREEDOM AVE
ELDERSBURG MD
21784-8061
US

IV. Provider business mailing address

2120 AGRIPPAS CT
ELDERSBURG MD
21784-6680
US

V. Phone/Fax

Practice location:
  • Phone: 410-751-3535
  • Fax:
Mailing address:
  • Phone: 443-821-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number03385L
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: