Provider Demographics
NPI:1174003198
Name:MCCOLLUM, ZACHARY LOUIS
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:LOUIS
Last Name:MCCOLLUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-1397
Mailing Address - Country:US
Mailing Address - Phone:563-556-7878
Mailing Address - Fax:
Practice Address - Street 1:1011 DAVIS ST
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-1306
Practice Address - Country:US
Practice Address - Phone:563-556-1259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician