Provider Demographics
NPI:1114253648
Name:LACALLE, ALLISON ADELE (AUD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:ADELE
Last Name:LACALLE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11361 SPRINKLE CUTOFF RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5409
Mailing Address - Country:US
Mailing Address - Phone:337-580-4778
Mailing Address - Fax:
Practice Address - Street 1:7200 WYOMING SPGS
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4303
Practice Address - Country:US
Practice Address - Phone:512-388-2217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-17
Last Update Date:2009-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80200231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX231H00000XMedicaid
TX231H00000XMedicare PIN
TX231H00000XMedicare UPIN
TX231H00000XMedicaid