Jackson Fayette McCullough Jr., B.S.

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SL001608L Issued in PA

Practice address

1732 Atkinson St
New Castle, PA 16101-1302

Phone

(724) 730-3414

NPI assigned

Jun 21, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1033314760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1732 ATKINSON ST",
            "city": "NEW CASTLE",
            "state": "PA",
            "postal_code": "161011302",
            "telephone_number": "724-730-3414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1732 ATKINSON ST",
            "city": "NEW CASTLE",
            "state": "PA",
            "postal_code": "161011302",
            "telephone_number": "724-730-3414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "JACKSON",
        "middle_name": "FAYETTE",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "B.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-21",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "PA",
            "license": "SL001608L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "19311180003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Morina Mazzanti, PA-C
• Michele Ann McClelland, LPC
• Diana McClure, LSW
• Lori McCollums, LPN
• Michael Cooper McCormick, D.D.S
• Erin Marie McDevitt, LCSW
• Robert McGann
• Kimberly McIntyre
• Laura Catherine McKain, MOT, OTR/L
• Dana M McKinney, SLP

• Speech-Language Pathologist in New Castle, PA
• Providers in New Castle, PA by specialty
• Speech-Language Pathologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.