MEDICARE: JENNIFER MCCULLOUGH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA18258	FL

General Provider Information

NPI Number	:	1639993975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MCCULLOUGH

Provider Business Mailing Address
First Line	:	3221 BROOKSIDE CT
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34688-9225
Country	:	US
Telephone Number	:	727-492-1434
Fax Number	:

Provider Business Practice Location Address
First Line	:	3221 BROOKSIDE CT
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34688-9225
Country	:	US
Telephone Number	:	727-492-1434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2024
Last Update Date	:	03/26/2026

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Directions to “ JENNIFER MCCULLOUGH ” Practice Location

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