Individual
DR. ETHAN MCCALLUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
2855 CAMPUS DR STE 400, PLYMOUTH, MN 55441-2659
(763) 577-7400
(763) 236-2650
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-9000
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
05/21/2014
Last updated
11/10/2020
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