Provider Demographics
NPI:1811120058
Name:MCCOLLUM, RACHAEL SUZANNE (BC-HIS)
Entity type:Individual
Prefix:MS
First Name:RACHAEL
Middle Name:SUZANNE
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:MRS
Other - First Name:RACHAEL
Other - Middle Name:SUZANNE
Other - Last Name:MCCOLLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BC-HIS
Mailing Address - Street 1:1790 S BETHEL RD STE A
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-5410
Mailing Address - Country:US
Mailing Address - Phone:256-822-2211
Mailing Address - Fax:
Practice Address - Street 1:1790 S BETHEL RD STE A
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-5410
Practice Address - Country:US
Practice Address - Phone:256-822-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237600000X
AL4175237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter