MEDICARE: MAGNOLIA THERAPY SOLUTIONS

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
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1992575948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNOLIA THERAPY SOLUTIONS

Provider Business Mailing Address
First Line	:	1391 W 5TH AVE # 401
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-2902
Country	:	US
Telephone Number	:	504-250-6422
Fax Number	:

Provider Business Practice Location Address
First Line	:	1391 W 5TH AVE # 401
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-2902
Country	:	US
Telephone Number	:	504-250-6422
Fax Number	:	504-354-8078

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	ASHLEY SCOTT
Credential	:	SLP, BCBA
Telephone Number	:	504-250-6422

Provider Enumeration Date	:	01/02/2024
Last Update Date	:	01/02/2024

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Directions to “MAGNOLIA THERAPY SOLUTIONS ” Practice Location

Language	Start Address	Practice Location

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