Provider Demographics
NPI:1447685904
Name:MCCULLEY, SAMANTHA LEE (SLP-CCC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LEE
Last Name:MCCULLEY
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:LEE
Other - Last Name:HOLBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:408 BELLEVIEW DR SE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37323-7565
Mailing Address - Country:US
Mailing Address - Phone:234-533-3594
Mailing Address - Fax:
Practice Address - Street 1:408 BELLEVIEW DR SE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37323-7565
Practice Address - Country:US
Practice Address - Phone:423-453-3359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5811235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist