Provider Demographics
NPI:1346573730
Name:MAGNIFICENT KIDS LLC
Entity Type:Organization
Organization Name:MAGNIFICENT KIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGNIFICO
Authorized Official - Suffix:
Authorized Official - Credentials:MA/CCC-SLP
Authorized Official - Phone:603-924-7722
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-0071
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:70 MAIN ST.
Practice Address - Street 2:SUITE 201
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1238
Practice Address - Country:US
Practice Address - Phone:603-924-7722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1111235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3072607Medicaid
NH561822OtherAETNA
NH626514OtherHARVARD PILGRIM
NH99560056Medicaid
NH66Y011091NH01OtherANTHEM BCBS
NH272746OtherCIGNA
NH761242OtherTUFTS