Provider Demographics
NPI:1275983504
Name:MCGOUGH, KORRINE BETHANY (MS ED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KORRINE
Middle Name:BETHANY
Last Name:MCGOUGH
Suffix:
Gender:F
Credentials:MS ED, CCC-SLP
Other - Prefix:MISS
Other - First Name:KORRINE
Other - Middle Name:BETHANY
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS ED, CCC-SLP
Mailing Address - Street 1:COHOES CITY SCHOOL DISTRICT: OFFICE OF SPECIAL PROGRAMS
Mailing Address - Street 2:21 PAGE AVENUE
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047
Mailing Address - Country:US
Mailing Address - Phone:518-237-0100
Mailing Address - Fax:518-237-2912
Practice Address - Street 1:HARMONY HILL ELEMENTARY SCHOOL
Practice Address - Street 2:120 MADELINE HICKEY WAY
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047
Practice Address - Country:US
Practice Address - Phone:518-233-1900
Practice Address - Fax:518-237-1964
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY026807235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program