Provider Demographics
NPI:1063997427
Name:MCGOLDRICK, KACIE
Entity type:Individual
Prefix:
First Name:KACIE
Middle Name:
Last Name:MCGOLDRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 AMSTERDAM AVE APT 4A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5862
Mailing Address - Country:US
Mailing Address - Phone:419-344-8266
Mailing Address - Fax:
Practice Address - Street 1:40 E 30TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-7374
Practice Address - Country:US
Practice Address - Phone:212-810-4120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist