Provider Demographics
NPI:1487268678
Name:MAGNOLIA SPEECH PATHOLOGY LLC
Entity type:Organization
Organization Name:MAGNOLIA SPEECH PATHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WEATHERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-572-8586
Mailing Address - Street 1:3400 SE 30TH TER
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6822
Mailing Address - Country:US
Mailing Address - Phone:352-578-2252
Mailing Address - Fax:352-578-1691
Practice Address - Street 1:3400 SE 30TH TER
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6822
Practice Address - Country:US
Practice Address - Phone:352-572-8586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty