Doctor Name: | JENNIFER MCCULLOUGH |
NPI Number: | 1073683942 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S.,CCC-SLP |
License Number: | SLP0004029 |
Business Practice Address: | 6075 Atlantic Blvd Suite G-1 Norcross, GA - 300711349 |
Business Phone Number: | 7702099826 |
Business Fax Number: | 7702099876 |
Mailing Address: | 303 Third Ave, DECATUR |
State: | GA |
Postal Code: | 300303567 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 11/08/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SLP0004029 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
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 |