Provider Demographics
NPI:1659339521
Name:MCCABE, PAULA MARIE (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:MARIE
Last Name:MCCABE
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 79302
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-0302
Mailing Address - Country:US
Mailing Address - Phone:817-691-4919
Mailing Address - Fax:
Practice Address - Street 1:149 HART ST
Practice Address - Street 2:82D MDG/AMDS/SGPA
Practice Address - City:SHEPPARD AFB
Practice Address - State:TX
Practice Address - Zip Code:76311-3477
Practice Address - Country:US
Practice Address - Phone:940-676-2143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51446231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD 000Medicare UPIN