Provider Demographics
NPI:1639202088
Name:MCGOWAN, GRETCHEN MARIE (MA, SLP, CCC)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:MARIE
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:MA, SLP, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 COOPER RD
Mailing Address - Street 2:
Mailing Address - City:SLIPPERY ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:16057-4519
Mailing Address - Country:US
Mailing Address - Phone:724-368-3735
Mailing Address - Fax:724-368-3735
Practice Address - Street 1:211 COOPER RD
Practice Address - Street 2:
Practice Address - City:SLIPPERY ROCK
Practice Address - State:PA
Practice Address - Zip Code:16057-4519
Practice Address - Country:US
Practice Address - Phone:724-368-3735
Practice Address - Fax:724-368-3735
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL001627L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist