Individual
MS. TEDDI LEE MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
833 LITCHFIELD ST, WICHITA, KS 67203-3106
(316) 269-4539
Mailing address
833 LITCHFIELD ST, WICHITA, KS 67203-3106
(316) 269-4539
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26-3288910
EMPLOYER INDENTIFICATION NUMBER-IRS
KS
Enumeration date
09/05/2008
Last updated
09/05/2008
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