Leisa Annette McCullough, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

S3909 Issued in MS

Practice address

2500 N State St
Jackson, MS 39216-4500

Phone

(662) 397-8964

NPI assigned

May 10, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1494374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494374400000",
    "number": "1699201715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "144 HUBER ST",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106983",
            "telephone_number": "662-397-8964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "662-397-8964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "LEISA",
        "middle_name": "ANNETTE",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-05-10",
        "last_updated": "2017-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MS",
            "license": "S3909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerry L McCraw, RRT
• Morgan McCray
• Samuel R McCreary, RBT
• Amanda McCullough, NP-C
• Darryl McCullough
• Evan Pike McCutchen
• Brandon Thomas McDaniel, MD
• Elijah McDaniel
• Jennifer Eden McDaniel, CPNP-AC
• Jordan Alyse Healy McDaniel

• Speech-Language Pathologist in Jackson, MS
• Providers in Jackson, MS by specialty
• Speech-Language Pathologist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2017; 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.