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General NPI Number Information
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NPI Number | 1205221785
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Entity Type | Organization
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Legal Business Name | MAGNOLIA SPEAKS SPEECH THERAPY CENTER
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Dates
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Enumeration Date | 04/01/2015
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Last Update Date | 03/30/2017
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Provider Practice Location Address
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Address Line | 1452 HUGHES RD SUITE 200
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City | GRAPEVINE
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State | TX
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Zip | 76051-7366
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Country | US
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Telephone | 601-566-5724
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Fax | 817-549-3609
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Provider Business Mailing Address
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Address Line | 1452 HUGHES RD SUITE 200
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City | GRAPEVINE
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State | TX
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Zip | 76051-7366
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Country | US
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Telephone | 601-566-5724
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Fax | 817-549-3609
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | LAKEISHA B FIELDS
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Credential | M.S.,CCC-SLP
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Telephone | 601-566-5724
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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 | 108116
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License Number State | TX
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