Provider Demographics
NPI:1598198517
Name:MCFALL, NANCY ALISSA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ALISSA
Last Name:MCFALL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 SUNSET BOULEVARD SUITE 510
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELESE
Mailing Address - State:CA
Mailing Address - Zip Code:90027
Mailing Address - Country:US
Mailing Address - Phone:323-644-9380
Mailing Address - Fax:323-644-9381
Practice Address - Street 1:5000 SUNSET BOULEVARD SUITE 510
Practice Address - Street 2:
Practice Address - City:LOS ANGELESE
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:323-644-9380
Practice Address - Fax:323-644-9381
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17694235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA264472978OtherPRIVATE PRACTICE