Provider Demographics
NPI:1174753560
Name:MCCALL, DEBRA ANN (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ANN
Last Name:MCCALL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CHASE LN
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-9461
Mailing Address - Country:US
Mailing Address - Phone:607-351-8833
Mailing Address - Fax:
Practice Address - Street 1:11 CHASE LN
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-9461
Practice Address - Country:US
Practice Address - Phone:607-351-8833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007403-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist