| Doctor Name: | MR. JACKSON FAYETTE MCCULLOUGH |
| NPI Number: | 1033314760 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | B.S. |
| License Number: | SL001608L |
| Business Practice Address: | 1732 Atkinson St New Castle, PA - 161011302 |
| Business Phone Number: | 7247303414 |
| Business Fax Number: | |
| Mailing Address: | 1732 Atkinson St, NEW CASTLE |
| State: | PA |
| Postal Code: | 161011302 |
| Phone Number: | 7247303414 |
| Fax Number: | |
| NPI Enumeration Date: | 06/21/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SL001608L |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |