Healthcare Provider Details

I. General information

NPI: 1821372533
Provider Name (Legal Business Name): LAURIE ELIZABETH MCCALL SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 SW RESERVOIR DR
REDMOND OR
97756-9481
US

IV. Provider business mailing address

1106 NW STANNIUM RD
BEND OR
97701-2141
US

V. Phone/Fax

Practice location:
  • Phone: 541-548-5066
  • Fax:
Mailing address:
  • Phone: 541-408-4944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12434
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: