Provider Demographics
NPI:1821372533
Name:MCCALL, LAURIE ELIZABETH (SLP)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ELIZABETH
Last Name:MCCALL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 NW STANNIUM RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-2141
Mailing Address - Country:US
Mailing Address - Phone:541-408-4944
Mailing Address - Fax:
Practice Address - Street 1:3025 SW RESERVOIR DR
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-9481
Practice Address - Country:US
Practice Address - Phone:541-548-5066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12434235Z00000X
CA6470235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist