MEDICARE: SARA ELAINE MCGRATH MS-CCC, SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	7267	MN

General Provider Information

NPI Number	:	1619104577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA ELAINE MCGRATH MS-CCC, SLP

Provider Business Mailing Address
First Line	:	223 SHAMROCK DR
Second Line	:
City	:	MAHTOMEDI
State	:	MN
Zip	:	55115-1760
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 SHAMROCK DR
Second Line	:
City	:	MAHTOMEDI
State	:	MN
Zip	:	55115-1760
Country	:	US
Telephone Number	:	651-253-9462
Fax Number	:	715-549-9213

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2009
Last Update Date	:	06/18/2009

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