Provider Demographics
NPI:1760554000
Name:MC COY, DEANNA M (ACA, BC-HIS)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:M
Last Name:MC COY
Suffix:
Gender:F
Credentials:ACA, BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 MANGROVE AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2620
Mailing Address - Country:US
Mailing Address - Phone:530-342-8132
Mailing Address - Fax:530-342-1174
Practice Address - Street 1:1600 MANGROVE AVE STE 160
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2620
Practice Address - Country:US
Practice Address - Phone:530-342-8132
Practice Address - Fax:530-342-1174
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA3884237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00400PCHZZZ35014Z40OtherBLUE SHIELD
CAHA0038840Medicaid
CA00400PCHZZZ35014Z0OtherBLUE CROSS