Provider Demographics
NPI:1770619132
Name:MCCULLY, PATTI A (HIS)
Entity type:Individual
Prefix:MS
First Name:PATTI
Middle Name:A
Last Name:MCCULLY
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 FRANCE AVE S
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435
Mailing Address - Country:US
Mailing Address - Phone:952-929-2060
Mailing Address - Fax:952-929-2067
Practice Address - Street 1:7600 FRANCE AVE S
Practice Address - Street 2:SUITE 1100
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-929-2060
Practice Address - Fax:952-929-2067
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2468237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist