Provider Demographics
NPI:1326617333
Name:GINEEN MAGIERA SPEECH PATHOLOGY AND WELLNESS LLC
Entity Type:Organization
Organization Name:GINEEN MAGIERA SPEECH PATHOLOGY AND WELLNESS LLC
Other - Org Name:PHOENIX SWALLOWING DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGIERA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:920-374-3946
Mailing Address - Street 1:2611 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-6621
Mailing Address - Country:US
Mailing Address - Phone:920-374-3946
Mailing Address - Fax:888-920-1975
Practice Address - Street 1:2611 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-6621
Practice Address - Country:US
Practice Address - Phone:920-374-3946
Practice Address - Fax:888-920-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty