Provider Demographics
NPI:1881010742
Name:MCCARTHY, MORGANNE GWYN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MORGANNE
Middle Name:GWYN
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:MORGANNE
Other - Middle Name:BURLEIGH
Other - Last Name:GWYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23 BROADLEAF DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-3009
Mailing Address - Country:US
Mailing Address - Phone:570-815-4932
Mailing Address - Fax:
Practice Address - Street 1:791 MIDDLE TPKE W
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-1819
Practice Address - Country:US
Practice Address - Phone:860-649-5396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8625235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist