Provider Demographics
NPI:1336215193
Name:MCCULLOCH, MARGARET D (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:D
Last Name:MCCULLOCH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S. GRADY WAY
Mailing Address - Street 2:STE 250
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-3215
Mailing Address - Country:US
Mailing Address - Phone:425-277-5492
Mailing Address - Fax:425-277-7553
Practice Address - Street 1:15 S. GRADY WAY
Practice Address - Street 2:STE 250
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-3215
Practice Address - Country:US
Practice Address - Phone:425-277-5492
Practice Address - Fax:425-277-7553
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000058581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000103587Medicare ID - Type Unspecified