Provider Demographics
NPI:1598226730
Name:MCCULLOUGH, EMILY LUISA (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:LUISA
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9323 MEREDITH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1879
Mailing Address - Country:US
Mailing Address - Phone:301-379-1876
Mailing Address - Fax:
Practice Address - Street 1:401 OLNEY SANDY SPRING RD
Practice Address - Street 2:
Practice Address - City:SANDY SPRING
Practice Address - State:MD
Practice Address - Zip Code:20860-1008
Practice Address - Country:US
Practice Address - Phone:240-740-0960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08818235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist