MEDICARE: ABIGAIL ANN MCCOWAN

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	8469	SC

General Provider Information

NPI Number	:	1508549643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL ANN MCCOWAN

Provider Business Mailing Address
First Line	:	4969 CHATEAU AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-4808
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8310 RIVERS AVE STE D
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9268
Country	:	US
Telephone Number	:	843-588-5677
Fax Number	:

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

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	12/18/2024

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