Provider Demographics
NPI:1063029742
Name:MCCULLOUGH, KARA VICTORIA (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:VICTORIA
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954-1506
Mailing Address - Country:US
Mailing Address - Phone:267-262-1422
Mailing Address - Fax:
Practice Address - Street 1:6401 MARTINS MILL RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-5304
Practice Address - Country:US
Practice Address - Phone:215-697-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist