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General NPI Number Information
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NPI Number | 1255574232
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Entity Type | Individual
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Provider Name | JASON MCCULLEY H.I.S.
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Gender | Male
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Dates
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Enumeration Date | 04/07/2009
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Last Update Date | 03/24/2015
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Provider Practice Location Address
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Address Line | 3908 S WALNUT ST SUITE B
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City | BLOOMINGTON
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State | IN
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Zip | 47401-7393
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Country | US
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Telephone | 812-329-0242
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Fax |
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Provider Business Mailing Address
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Address Line | 3908 S WALNUT ST SUITE B
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City | BLOOMINGTON
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State | IN
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Zip | 47401-7393
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Country | US
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Telephone | 812-329-0242
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235500000X
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Taxonomy Name | Speech/Language/Hearing Specialist/Technologist
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License Number | 17001313A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 235500000X
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Taxonomy Name | Speech/Language/Hearing Specialist/Technologist
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License Number | 603
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number |
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License Number State |
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