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General NPI Number Information
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NPI Number | 1467032953
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Entity Type | Organization
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Legal Business Name | MAGNOLIA THERAPY LLC
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Dates
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Enumeration Date | 04/09/2021
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Last Update Date | 05/23/2022
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Provider Practice Location Address
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Address Line | 1502 S COLORADO ST
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City | GREENVILLE
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State | MS
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Zip | 38703-7219
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Country | US
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Telephone | 662-579-8508
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Fax | 601-586-8334
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Provider Business Mailing Address
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Address Line | 206 SYCAMORE ST
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City | LELAND
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State | MS
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Zip | 38756-3139
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Country | US
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Telephone | 662-820-5044
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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 | ASHLEY BROWN CORBAN
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Credential | MS, CCC-SLP
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Telephone | 662-579-8508
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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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