Provider Demographics
NPI:1750847364
Name:MCGRATH, AMY (SLP CCC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:SLP CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-3246
Mailing Address - Country:US
Mailing Address - Phone:818-599-0189
Mailing Address - Fax:
Practice Address - Street 1:30 OAKWOOD RD
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-3246
Practice Address - Country:US
Practice Address - Phone:818-599-0189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028262235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist