Provider Demographics
NPI:1144766502
Name:MCGIVER, CORNELIA (MS SLP CCC)
Entity Type:Individual
Prefix:
First Name:CORNELIA
Middle Name:
Last Name:MCGIVER
Suffix:
Gender:F
Credentials:MS SLP CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 BLOCK FACTORY RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12526-5203
Mailing Address - Country:US
Mailing Address - Phone:914-388-2516
Mailing Address - Fax:
Practice Address - Street 1:82 BLOCK FACTORY RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:NY
Practice Address - Zip Code:12526-5203
Practice Address - Country:US
Practice Address - Phone:914-388-2516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008603235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist