1275983504 NPI number — MRS. KORRINE BETHANY MCGOUGH M.S. ED., CCC-SLP

Table of content: MRS. KORRINE BETHANY MCGOUGH M.S. ED., CCC-SLP (NPI 1275983504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275983504 NPI number — MRS. KORRINE BETHANY MCGOUGH M.S. ED., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGOUGH
Provider First Name:
KORRINE
Provider Middle Name:
BETHANY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S. ED., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARSHALL
Provider Other First Name:
KORRINE
Provider Other Middle Name:
BETHANY
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S. ED., CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275983504
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
COHOES CITY SCHOOL DISTRICT: OFFICE OF SPECIAL PROGRAMS
Provider Second Line Business Mailing Address:
21 PAGE AVENUE
Provider Business Mailing Address City Name:
COHOES
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-237-0100
Provider Business Mailing Address Fax Number:
518-237-2912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HARMONY HILL ELEMENTARY SCHOOL
Provider Second Line Business Practice Location Address:
120 MADELINE HICKEY WAY
Provider Business Practice Location Address City Name:
COHOES
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-233-1900
Provider Business Practice Location Address Fax Number:
518-237-1964
Provider Enumeration Date:
06/17/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 026807 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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