Provider Demographics
NPI:1073527891
Name:MCCLINTOCK, FERNE ELIZABETH (MS CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:FERNE
Middle Name:ELIZABETH
Last Name:MCCLINTOCK
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 OFFICE PARK CIRCLE
Mailing Address - Street 2:STE 301
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35223
Mailing Address - Country:US
Mailing Address - Phone:205-871-3878
Mailing Address - Fax:205-871-3902
Practice Address - Street 1:4 OFFICE PARK CIRCLE
Practice Address - Street 2:STE 301
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35223
Practice Address - Country:US
Practice Address - Phone:205-871-3878
Practice Address - Fax:205-871-3902
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL721235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL10274OtherHEALTH SPRING
AL51043670OtherBLUE CROSS BLUE SHIELD