Basic Information
| Provider Information | |||||||||
| NPI: | 1417292871 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALLAWAY MCNEELY | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | LAVON | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | HIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1220 N TOWN EAST BLVD STE 214 | ||||||||
| Address2: | |||||||||
| City: | MESQUITE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751504682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722702202 | ||||||||
| FaxNumber: | 9722790649 | ||||||||
| Practice Location | |||||||||
| Address1: | 1220 N TOWN EAST BLVD STE 214 | ||||||||
| Address2: | |||||||||
| City: | MESQUITE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751504682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722702202 | ||||||||
| FaxNumber: | 9722790649 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2012 | ||||||||
| LastUpdateDate: | 12/11/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 11065 | TX | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.