Provider Demographics
NPI:1063006781
Name:MCCUNE, ELIZABETH CAILEEN
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CAILEEN
Last Name:MCCUNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 STARS AND STRIPES
Mailing Address - Street 2:
Mailing Address - City:FISCHER
Mailing Address - State:TX
Mailing Address - Zip Code:78623-2122
Mailing Address - Country:US
Mailing Address - Phone:214-418-6425
Mailing Address - Fax:
Practice Address - Street 1:550 STARS AND STRIPES
Practice Address - Street 2:
Practice Address - City:FISCHER
Practice Address - State:TX
Practice Address - Zip Code:78623-2122
Practice Address - Country:US
Practice Address - Phone:214-418-6425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist