Provider Demographics
NPI:1063569911
Name:MCCALL, LISA H (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:H
Last Name:MCCALL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MICHELLE
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:616 PARK YORK LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-5639
Mailing Address - Country:US
Mailing Address - Phone:919-363-2056
Mailing Address - Fax:
Practice Address - Street 1:4020 BARRETT DR
Practice Address - Street 2:SUITE 205
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6624
Practice Address - Country:US
Practice Address - Phone:919-787-4400
Practice Address - Fax:919-510-0070
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3383235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11844OtherBCBSNC PIN
NC7411414Medicaid