Provider Demographics
NPI:1093204463
Name:MACCALLUM, ROSE
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:MACCALLUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 E HENDELMEYER AVE
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-4284
Mailing Address - Country:US
Mailing Address - Phone:717-490-0891
Mailing Address - Fax:
Practice Address - Street 1:407 E HENDELMEYER AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-4284
Practice Address - Country:US
Practice Address - Phone:217-685-0747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health