Mccullough, Jackson Fayette

Mccullough, Jackson Fayette is an sole proprietor health care provider with primary practice located at 1732 Atkinson St , New Castle PA 16101-1302. He recently has only one registered license in Speech, Language and Hearing Service Providers / Speech-Language Pathologist, which is considered as his primary health care specialty. Mccullough, Jackson Fayette can be contacted via phone (724) 730-3414.

Contact Information

Primary practice address
1732 Atkinson St New Castle PA 16101-1302
Phone: (724) 730-3414
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Speech, Language and Hearing Service Providers / Speech-Language Pathologist 235Z00000X SL001608L Pennsylvania

Profile Details

NPI number 1033314760
LBN Legal business name Mccullough, Jackson Fayette
Credentials B.S.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 21st, 2007
Last updated Jul 9th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033314760 NPPES
Pennsylvania MEDICAID 19311180003

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