Healthcare Provider Details

I. General information

NPI: 1417866625
Provider Name (Legal Business Name): MAGNOLIA VOICE AND SWALLOWING SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 N IRONWOOD RD STE 203
GLENDALE WI
53217-4909
US

IV. Provider business mailing address

5225 N IRONWOOD RD STE 203
GLENDALE WI
53217-4909
US

V. Phone/Fax

Practice location:
  • Phone: 414-293-2481
  • Fax:
Mailing address:
  • Phone: 414-293-2481
  • Fax:

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: KIMBERLY DUNCAN
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: MA, CCC-SLP
Phone: 414-293-2481