Healthcare Provider Details

I. General information

NPI: 1710899190
Provider Name (Legal Business Name): CHERYL MAGNUSSON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 CHESTNUT AVE
DU BOIS PA
15801-2988
US

IV. Provider business mailing address

333 TREASURE LK
DU BOIS PA
15801-9008
US

V. Phone/Fax

Practice location:
  • Phone: 814-371-1088
  • Fax:
Mailing address:
  • Phone: 814-371-1088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW144779
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: