Provider Demographics
NPI:1205221785
Name:MAGNOLIA SPEAKS SPEECH THERAPY CENTER
Entity Type:Organization
Organization Name:MAGNOLIA SPEAKS SPEECH THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LAKEISHA
Authorized Official - Middle Name:B
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP
Authorized Official - Phone:601-566-5724
Mailing Address - Street 1:1452 HUGHES RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7366
Mailing Address - Country:US
Mailing Address - Phone:601-566-5724
Mailing Address - Fax:817-549-3609
Practice Address - Street 1:1452 HUGHES RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7366
Practice Address - Country:US
Practice Address - Phone:601-566-5724
Practice Address - Fax:817-549-3609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-01
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108116235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty