Provider Demographics
NPI:1598940603
Name:MAGNESS, MEREDITH 'MOLLY' J (AUD)
Entity type:Individual
Prefix:
First Name:MEREDITH 'MOLLY'
Middle Name:J
Last Name:MAGNESS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MEREDITH 'MOLLY'
Other - Middle Name:J
Other - Last Name:QUATTRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:2500 FOUNDATION WAY
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-9000
Mailing Address - Country:US
Mailing Address - Phone:304-264-9202
Mailing Address - Fax:304-264-9042
Practice Address - Street 1:2000 FOUNDATION WAY
Practice Address - Street 2:STE 3200
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-9003
Practice Address - Country:US
Practice Address - Phone:304-262-9400
Practice Address - Fax:304-262-9407
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006058231H00000X
WVA-0257231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810019517Medicaid
PAAT006058OtherLICENSE
PAAT006058OtherLICENSE