Healthcare Provider Details

I. General information

NPI: 1689980815
Provider Name (Legal Business Name): IAN PATRICK MCGARTY CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 OLDE LANTERN RD
BEDFORD NH
03110-4814
US

IV. Provider business mailing address

11 SUMMER ST
GOFFSTOWN NH
03045-1721
US

V. Phone/Fax

Practice location:
  • Phone: 603-623-8863
  • Fax:
Mailing address:
  • Phone: 603-767-2786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1311
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: