Individual
LEISA ANNETTE MCCULLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(662) 397-8964
Mailing address
144 HUBER ST, MADISON, MS 39110-6983
(662) 397-8964
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S3909
MS
Other
Enumeration date
05/10/2017
Last updated
05/10/2017
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