Provider Demographics
NPI:1588602288
Name:CULLUM, ANNA (SLP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:CULLUM
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 1:1420 BRECKENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-4825
Mailing Address - Country:US
Mailing Address - Phone:501-837-1677
Mailing Address - Fax:
Practice Address - Street 1:1420 BRECKENRIDGE DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-4826
Practice Address - Country:US
Practice Address - Phone:501-837-1677
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2174235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist