Healthcare Provider Details

I. General information

NPI: 1508119264
Provider Name (Legal Business Name): CORTNEY MARGARET MCGRAW M.S.,CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CORTNEY MARGARET LOCKNANE M.S.,CCC-SLP

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N. ALLEGHANEY
ODESSA TX
79761
US

IV. Provider business mailing address

620 N. ALLEGHANEY
ODESSA TX
79761
US

V. Phone/Fax

Practice location:
  • Phone: 432-332-8244
  • Fax: 432-580-7428
Mailing address:
  • Phone: 432-332-8244
  • Fax: 432-580-7428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number105913
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5208
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: