Provider Demographics
NPI:1235645128
Name:MCCARTHY, ANN BONNER (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:BONNER
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:ANNIE
Other - Middle Name:BONNER
Other - Last Name:DUCKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:340 E 86TH ST APT 18
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-4661
Mailing Address - Country:US
Mailing Address - Phone:484-832-3498
Mailing Address - Fax:
Practice Address - Street 1:373 MAIN ST UNIT B
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5903
Practice Address - Country:US
Practice Address - Phone:917-843-7134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-14
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NY026814235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty