Provider Demographics
NPI:1891099404
Name:MCGOWAN, TONIA LEA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:LEA
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-1641
Mailing Address - Country:US
Mailing Address - Phone:845-786-3454
Mailing Address - Fax:
Practice Address - Street 1:142 LAKE RD
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-2470
Practice Address - Country:US
Practice Address - Phone:845-353-7254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018364235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist