Provider Demographics
NPI:1013244862
Name:MCCULLOUGH, HELGA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HELGA
Middle Name:
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:MS 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:HC 1 BOX 1380
Mailing Address - Street 2:
Mailing Address - City:BLAKESLEE
Mailing Address - State:PA
Mailing Address - Zip Code:18610-9407
Mailing Address - Country:US
Mailing Address - Phone:570-643-8095
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 1380
Practice Address - Street 2:
Practice Address - City:BLAKESLEE
Practice Address - State:PA
Practice Address - Zip Code:18610-9407
Practice Address - Country:US
Practice Address - Phone:570-643-8095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007486235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist