Healthcare Provider Details

I. General information

NPI: 1316163389
Provider Name (Legal Business Name): MAGNOLIA SPEECH SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 N FLAG CHAPEL RD
JACKSON MS
39209-2206
US

IV. Provider business mailing address

733 N FLAG CHAPEL RD
JACKSON MS
39209-2206
US

V. Phone/Fax

Practice location:
  • Phone: 601-922-5530
  • Fax: 601-922-5534
Mailing address:
  • Phone: 601-922-5530
  • Fax: 601-922-5534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateMS

VIII. Authorized Official

Name: MRS. ADDIE HOLIFIELD
Title or Position: BUSINESS MANAGER
Credential:
Phone: 601-922-5530