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General NPI Number Information
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NPI Number | 1366507576
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Entity Type | Organization
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Legal Business Name | MCGOWENTHERAPY SERVICES, INC.
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1471 GRIST MILL DR
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City | ACWORTH
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State | GA
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Zip | 30101-8623
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Country | US
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Telephone | 770-639-6443
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Fax |
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Provider Business Mailing Address
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Address Line | 1471 GRIST MILL DRIVE
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City | ACWORTH
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State | GA
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Zip | 30101-8623
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Country | US
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Telephone | 770-639-6443
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Fax |
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Authorized Official
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Title or Position | OWNER, SPEECH LANGUAGE PATHOLOGIST
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Name | LAURA MCGOWEN
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Credential | M.S., CCC-SLP
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Telephone | 770-639-6443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 4454
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License Number State | GA
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