Provider Demographics
NPI:1538451901
Name:MCCALL, REBECCA S
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:MCCALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:S
Other - Last Name:MCCALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSW
Mailing Address - Street 1:400 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WAMEGO
Mailing Address - State:KS
Mailing Address - Zip Code:66547-1835
Mailing Address - Country:US
Mailing Address - Phone:785-844-0078
Mailing Address - Fax:785-456-9520
Practice Address - Street 1:400 6TH ST
Practice Address - Street 2:
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547-1835
Practice Address - Country:US
Practice Address - Phone:785-844-2440
Practice Address - Fax:785-456-9520
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS90-0715502251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200733740AMedicaid