Provider Demographics
NPI:1285205518
Name:LANKFORD, CALLIE GRACE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CALLIE
Middle Name:GRACE
Last Name:LANKFORD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 GREENBRIER AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-4820
Mailing Address - Country:US
Mailing Address - Phone:217-497-6043
Mailing Address - Fax:
Practice Address - Street 1:325 E ORANGE ST
Practice Address - Street 2:
Practice Address - City:HOOPESTON
Practice Address - State:IL
Practice Address - Zip Code:60942-1605
Practice Address - Country:US
Practice Address - Phone:217-497-6043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146012840235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist