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General NPI Number Information
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NPI Number | 1972653988
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Entity Type | Individual
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Provider Name | LAWRENCE WAYNE MCCALLUM PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 639 38TH ST
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City | ROCK ISLAND
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State | IL
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Zip | 61201-2210
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Country | US
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Telephone | 309-794-7373
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Fax |
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Provider Business Mailing Address
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Address Line | 1214 PINEHILL RD
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City | BETTENDORF
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State | IA
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Zip | 52722-1718
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Country | US
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Telephone | 563-355-3474
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0071003425
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License Number State | IL
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