Provider Demographics
NPI:1194806562
Name:NANCY DEMETER MCCALL
Entity type:Organization
Organization Name:NANCY DEMETER MCCALL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:DEMETER
Authorized Official - Last Name:MCCALL
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:919-734-1773
Mailing Address - Street 1:205 GLEN OAK DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-1705
Mailing Address - Country:US
Mailing Address - Phone:919-734-1773
Mailing Address - Fax:
Practice Address - Street 1:205 GLEN OAK DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1705
Practice Address - Country:US
Practice Address - Phone:919-734-1773
Practice Address - Fax:919-580-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1253235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211590Medicaid