MEDICARE: MAGNOLIA PEDIATRIC THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1144178070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNOLIA PEDIATRIC THERAPY

Provider Business Mailing Address
First Line	:	1634 W BLOOMINGDALE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-1530
Country	:	US
Telephone Number	:	815-766-0876
Fax Number	:

Provider Business Practice Location Address
First Line	:	1634 W BLOOMINGDALE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-1530
Country	:	US
Telephone Number	:	815-766-0876
Fax Number	:

Authorized Official
Title or Position	:	SPEECH-LANGUAGE PATHOLOGIST
Name	:	MAGGIE E RAPP
Credential	:	CCC-SLP
Telephone Number	:	815-766-0876

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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Directions to “MAGNOLIA PEDIATRIC THERAPY ” Practice Location

Language	Start Address	Practice Location

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