Provider Demographics
NPI:1538441290
Name:MCGOUGH, KATHRYN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:MCGOUGH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 HUDSON ST
Mailing Address - Street 2:APT 4
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-2496
Mailing Address - Country:US
Mailing Address - Phone:201-519-4460
Mailing Address - Fax:
Practice Address - Street 1:551 HUDSON ST
Practice Address - Street 2:APT 4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-2496
Practice Address - Country:US
Practice Address - Phone:201-519-4460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY868861235Z00000X
NJ41YS00499400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist