Provider Demographics
NPI:1073972899
Name:MCCOURRY, CAROLINE O'CONNOR (MSP, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:O'CONNOR
Last Name:MCCOURRY
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-3158
Mailing Address - Country:US
Mailing Address - Phone:843-254-1890
Mailing Address - Fax:
Practice Address - Street 1:105 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-3158
Practice Address - Country:US
Practice Address - Phone:843-254-1890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5578235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist