Provider Demographics
NPI:1487252706
Name:MCCULLOUGH, JANICE H (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:H
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 HIGHLAND CIR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3113
Mailing Address - Country:US
Mailing Address - Phone:979-587-9995
Mailing Address - Fax:
Practice Address - Street 1:2721 HIGHLAND CIR
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3113
Practice Address - Country:US
Practice Address - Phone:979-587-9995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR342235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist