Provider Demographics
NPI:1447068796
Name:MAGNOLIA SPEECH & LITERACY SPECIALISTS
Entity type:Organization
Organization Name:MAGNOLIA SPEECH & LITERACY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, SPEECH-LANGUAGE PATHOLOGISY
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:HAAN
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:404-285-5602
Mailing Address - Street 1:3778 LAVISTA RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5616
Mailing Address - Country:US
Mailing Address - Phone:404-285-5602
Mailing Address - Fax:
Practice Address - Street 1:3778 LAVISTA RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5616
Practice Address - Country:US
Practice Address - Phone:404-285-5602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty