Provider Demographics
NPI:1902670623
Name:MCCALL, LAURA DELL (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:DELL
Last Name:MCCALL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:DELL
Other - Last Name:BLALOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1212 BRIAR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-8373
Mailing Address - Country:US
Mailing Address - Phone:940-312-2188
Mailing Address - Fax:
Practice Address - Street 1:1212 BRIAR RIDGE DR
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-8373
Practice Address - Country:US
Practice Address - Phone:940-312-2188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105621235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist