Provider Demographics
NPI:1316163389
Name:MAGNOLIA SPEECH SCHOOL
Entity type:Organization
Organization Name:MAGNOLIA SPEECH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLIFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-922-5530
Mailing Address - Street 1:733 N FLAG CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39209-2206
Mailing Address - Country:US
Mailing Address - Phone:601-922-5530
Mailing Address - Fax:601-922-5534
Practice Address - Street 1:733 N FLAG CHAPEL RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209-2206
Practice Address - Country:US
Practice Address - Phone:601-922-5530
Practice Address - Fax:601-922-5534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS231H00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty