Provider Demographics
NPI:1124074182
Name:MCCOLLUM, LINDA A
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:MCCOLLUM
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 1:19405 EMERALD SQ STE 1100
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3639
Mailing Address - Country:US
Mailing Address - Phone:301-745-4820
Mailing Address - Fax:
Practice Address - Street 1:13424 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2658
Practice Address - Country:US
Practice Address - Phone:301-745-4820
Practice Address - Fax:240-527-2696
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02584237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist