Provider Demographics
NPI:1346059961
Name:MCCOWN, SERENA ELISE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:ELISE
Last Name:MCCOWN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 S HEDGES AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64052-2038
Mailing Address - Country:US
Mailing Address - Phone:719-568-1501
Mailing Address - Fax:
Practice Address - Street 1:5427 JOHNSON DR
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66205-2912
Practice Address - Country:US
Practice Address - Phone:913-912-2174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024033398235Z00000X
KS5672235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist