Healthcare Provider Details

I. General information

NPI: 1649848375
Provider Name (Legal Business Name): MACKENZIE CONDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 08/12/2025
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7905 SCHATZ POINTE DR STE 104
DAYTON OH
45459-0001
US

IV. Provider business mailing address

1628 E. DOROTHY LN
KETTERING OH
45429
US

V. Phone/Fax

Practice location:
  • Phone: 937-365-7455
  • Fax: 937-600-6071
Mailing address:
  • Phone: 937-750-8236
  • Fax: 937-600-6071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: