Healthcare Provider Details

I. General information

NPI: 1326975475
Provider Name (Legal Business Name): MAGNOLIA SPEECH AND LANGUAGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 GRAND PALM LN
SUMMERVILLE SC
29485-5859
US

IV. Provider business mailing address

717 OLD TROLLEY RD. STE 6, BOX 225
SUMMERVILLE SC
29485
US

V. Phone/Fax

Practice location:
  • Phone: 843-695-9886
  • Fax: 843-790-2303
Mailing address:
  • Phone: 843-695-9886
  • Fax: 843-790-2303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH EZZO
Title or Position: SLP
Credential: MS
Phone: 772-485-1742