Provider Demographics
NPI:1659527828
Name:MCCOY, REBECCA DANIELLE (AUD)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:DANIELLE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:DANIELLE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:101 W. MCKINLEY AVE.
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526
Mailing Address - Country:US
Mailing Address - Phone:217-876-3682
Mailing Address - Fax:217-876-3345
Practice Address - Street 1:101 W. MCKINLEY AVE.
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526
Practice Address - Country:US
Practice Address - Phone:217-876-3682
Practice Address - Fax:217-876-3345
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA . 01644237600000X
IL147.001324231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter