Provider Demographics
NPI:1043217128
Name:CALLEN, DOUGLAS NELSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:NELSON
Last Name:CALLEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S WATER ST
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-2437
Mailing Address - Country:US
Mailing Address - Phone:724-548-4455
Mailing Address - Fax:724-543-4491
Practice Address - Street 1:200 S WATER ST
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-2437
Practice Address - Country:US
Practice Address - Phone:724-548-4455
Practice Address - Fax:724-543-4491
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000075L237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA251537307OtherUPMC, UMWA FUNDS
PA0014183060003Medicaid
PA1015995OtherGATEWAY
PA1015995OtherGATEWAY