Provider Demographics
NPI:1861581589
Name:MCCULLOH, SARAH DAVIS (MSP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:DAVIS
Last Name:MCCULLOH
Suffix:
Gender:F
Credentials:MSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 GLEN CREST DR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:SC
Mailing Address - Zip Code:29369-9287
Mailing Address - Country:US
Mailing Address - Phone:864-486-8706
Mailing Address - Fax:
Practice Address - Street 1:2500 WINCHESTER PL
Practice Address - Street 2:SUITE 100
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-1550
Practice Address - Country:US
Practice Address - Phone:864-574-7282
Practice Address - Fax:864-574-7664
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3818235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3818OtherLICENSE NUMBER
SC3818OtherLICENSE NUMBER