Healthcare Provider Details

I. General information

NPI: 1992575948
Provider Name (Legal Business Name): MAGNOLIA THERAPY SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1391 W 5TH AVE # 401
COLUMBUS OH
43212-2902
US

IV. Provider business mailing address

1391 W 5TH AVE # 401
COLUMBUS OH
43212-2902
US

V. Phone/Fax

Practice location:
  • Phone: 504-250-6422
  • Fax: 504-354-8078
Mailing address:
  • Phone: 504-250-6422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY SCOTT
Title or Position: CLINICAL DIRECTOR
Credential: SLP, BCBA
Phone: 504-250-6422