Provider Demographics
NPI:1255587648
Name:MCCOLLUM, LORI G (MCD, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:G
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:MCD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3368 HIGHWAY 280
Mailing Address - Street 2:SUITE G-15
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-3393
Mailing Address - Country:US
Mailing Address - Phone:256-329-1114
Mailing Address - Fax:256-329-3339
Practice Address - Street 1:3368 HIGHWAY 280
Practice Address - Street 2:SUITE G-15
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3393
Practice Address - Country:US
Practice Address - Phone:256-329-1114
Practice Address - Fax:256-329-3339
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL813A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist