Provider Demographics
NPI:1053144147
Name:SCHUNKE, MCCALL ROSE
Entity type:Individual
Prefix:
First Name:MCCALL
Middle Name:ROSE
Last Name:SCHUNKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 AVIATION CTR
Mailing Address - Street 2:
Mailing Address - City:RANTOUL
Mailing Address - State:IL
Mailing Address - Zip Code:61866-3481
Mailing Address - Country:US
Mailing Address - Phone:217-893-5456
Mailing Address - Fax:
Practice Address - Street 1:1 AVIATION CTR
Practice Address - Street 2:
Practice Address - City:RANTOUL
Practice Address - State:IL
Practice Address - Zip Code:61866-3481
Practice Address - Country:US
Practice Address - Phone:217-893-5456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242007675235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist