Provider Demographics
NPI:1215172077
Name:MCCOY, KATHARINE L (SLP)
Entity type:Individual
Prefix:MRS
First Name:KATHARINE
Middle Name:L
Last Name:MCCOY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:KATIE
Other - Middle Name:L
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1603 COURT ST.
Mailing Address - Street 2:ENABLE
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13208
Mailing Address - Country:US
Mailing Address - Phone:315-455-7591
Mailing Address - Fax:315-455-2494
Practice Address - Street 1:620 WEST GENESEE ST.
Practice Address - Street 2:EXPLORING YOUR WORLD NURSERY SCHOOL
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204
Practice Address - Country:US
Practice Address - Phone:315-218-0296
Practice Address - Fax:315-471-6028
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017144235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist