Provider Demographics
NPI:1700856614
Name:MCCALLUM, GERALD CHRISTOPHER (PHD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:CHRISTOPHER
Last Name:MCCALLUM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4345
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60567-4345
Mailing Address - Country:US
Mailing Address - Phone:630-983-8400
Mailing Address - Fax:630-983-8402
Practice Address - Street 1:1555 N. NAPERVILLE WHEATON RD.
Practice Address - Street 2:SUITE 108
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1557
Practice Address - Country:US
Practice Address - Phone:630-983-8400
Practice Address - Fax:630-983-8402
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004781103TC0700X
IL071-004781103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL335002Medicare UPIN