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General NPI Number Information
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NPI Number | 1104774348
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Entity Type | Organization
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Legal Business Name | MAGNOLIA SPEECH & FEEDING THERAPY LLC
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Dates
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Enumeration Date | 03/20/2026
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Last Update Date | 03/20/2026
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Provider Practice Location Address
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Address Line | 29 FENWICK DR UNIT A
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City | CHARLESTON
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State | SC
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Zip | 29407-7537
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Country | US
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Telephone | 843-619-7120
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Fax |
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Provider Business Mailing Address
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Address Line | 112 HAWKINS ISLAND CIR
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City | ST SIMONS ISLAND
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State | GA
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Zip | 31522-1771
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | EMMA LOUISE TRACY
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Credential | MS, CCC-SLP, CLC
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Telephone | 843-619-7120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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