Provider Demographics
NPI:1760688493
Name:MCCULLOUGH, ERIKA L (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:L
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6121 MONROE PL
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-1248
Mailing Address - Country:US
Mailing Address - Phone:757-200-5906
Mailing Address - Fax:
Practice Address - Street 1:171 KEMPSVILLE RD
Practice Address - Street 2:BUILDING A-1
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4700
Practice Address - Country:US
Practice Address - Phone:757-668-6575
Practice Address - Fax:757-668-6588
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003596235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
09109854OtherASHA