Provider Demographics
NPI:1447500178
Name:MCCOLLOUGH, PATRICIA A (CNA)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:MCCOLLOUGH
Suffix:
Gender:
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5928
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63134-0928
Mailing Address - Country:US
Mailing Address - Phone:314-276-6984
Mailing Address - Fax:314-381-4499
Practice Address - Street 1:4720 BESSIE CT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63115-2101
Practice Address - Country:US
Practice Address - Phone:314-276-6984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator