Doctor Name: | JENNIFER MCCULLUM |
NPI Number: | 1326355033 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | S/L PATHOLOGIST |
License Number: | ME1650 |
Business Practice Address: | 14 Shaker Road Gray, ME - 04039 |
Business Phone Number: | 2076572066 |
Business Fax Number: | |
Mailing Address: | 110 Pennell Avenue, PORTLAND |
State: | ME |
Postal Code: | 04039 |
Phone Number: | 2077732507 |
Fax Number: | |
NPI Enumeration Date: | 09/02/2010 |
NPI Last Update Date: | 09/02/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | ME1650 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
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 |