MEDICARE: ALLYSON MAGNO M.A., CCC-SLP

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	146012108	IL

General Provider Information

NPI Number	:	1568977965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLYSON MAGNO M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	3102 VALERIE DR
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61822-1831
Country	:	US
Telephone Number	:	217-377-8532
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 S SHELDON ST
Second Line	:
City	:	RANTOUL
State	:	IL
Zip	:	61866-2431
Country	:	US
Telephone Number	:	217-892-2151
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2017
Last Update Date	:	12/06/2017

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