Provider Demographics
NPI:1225279870
Name:MCCULLEN, MEILY (SLP)
Entity Type:Individual
Prefix:MS
First Name:MEILY
Middle Name:
Last Name:MCCULLEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 TUXEDO CT
Mailing Address - Street 2:SUITE-B
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5261
Mailing Address - Country:US
Mailing Address - Phone:209-464-0200
Mailing Address - Fax:209-464-0220
Practice Address - Street 1:1522 VIRTUE ARC CT
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6026
Practice Address - Country:US
Practice Address - Phone:209-464-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 10850235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist