Provider Demographics
NPI:1710113279
Name:MCGOWAN, KATHY L (MACCC-A)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:L
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:MACCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4199 KINROSS LAKES PKWY
Mailing Address - Street 2:STE 220
Mailing Address - City:RICHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44286-9010
Mailing Address - Country:US
Mailing Address - Phone:234-400-0201
Mailing Address - Fax:234-400-0199
Practice Address - Street 1:4199 KINROSS LAKES PKWY
Practice Address - Street 2:STE 220
Practice Address - City:RICHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44286-9010
Practice Address - Country:US
Practice Address - Phone:234-400-0201
Practice Address - Fax:234-400-0199
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHM.A.CCC-A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist