MEDICARE: LAURA MCGINNISS MSP, 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	5200	SC

General Provider Information

NPI Number	:	1376963108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MCGINNISS MSP, CCC-SLP

Provider Business Mailing Address
First Line	:	10423 GURNARD ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-3302
Country	:	US
Telephone Number	:	864-616-0652
Fax Number	:

Provider Business Practice Location Address
First Line	:	407 BRIDGEWATER DR
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-1320
Country	:	US
Telephone Number	:	864-616-0652
Fax Number	:

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

Provider Enumeration Date	:	04/19/2014
Last Update Date	:	02/21/2024

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Directions to “ LAURA MCGINNISS MSP, CCC-SLP” Practice Location

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