Healthcare Provider Details

I. General information

NPI: 1922828599
Provider Name (Legal Business Name): MAGDA H SALEM PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S BROADVIEW ST
CAPE GIRARDEAU MO
63703-5759
US

IV. Provider business mailing address

112 S BROADVIEW ST
CAPE GIRARDEAU MO
63703-5759
US

V. Phone/Fax

Practice location:
  • Phone: 573-334-3486
  • Fax: 573-334-3524
Mailing address:
  • Phone: 573-334-3486
  • Fax: 573-334-3524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2024040675
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: