Individual
JENNIFER MCCULLUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
S/L PATHOLOGIST
Contact information
Practice address
14 SHAKER ROAD, GRAY, ME 04039
(207) 657-2066
Mailing address
110 PENNELL AVENUE, PORTLAND, ME 04039
(207) 773-2507
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
ME1650
ME
Other
Enumeration date
09/02/2010
Last updated
09/02/2010
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