Provider Demographics
NPI:1225480445
Name:MCGRATH, JESSA NICOLE (AUD)
Entity Type:Individual
Prefix:
First Name:JESSA
Middle Name:NICOLE
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:JESSA
Other - Middle Name:NICOLE
Other - Last Name:GOMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:
Practice Address - Street 1:6035 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3256
Practice Address - Country:US
Practice Address - Phone:704-295-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12075231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19PMSOtherBCBS NC
SC1259922OtherWELLCARE
NCQ54160AOtherMEDICARE
NCP01875989OtherRAILROAD MEDICARE
SCSAN134Medicaid