NPIMap

Organization Active NPI

Magnolia Pediatric Therapy, LLC

  • Speech-Language Pathologist
  • Lake Charles, LA
National Provider Identifier
1346690740
Registry record updated Mar 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
7129 Issued in LA
Legal business name
MAGNOLIA PEDIATRIC THERAPY, LLC
Practice address
3501 5TH Ave Ste a
Lake Charles, LA 70607-2155
Phone
(337) 419-0086
Fax
(337) 415-0626
NPI assigned
Jun 16, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Megan Musso, M.A., CCC-SLPNPI 1649682493
Title
Manager/Owner
Phone
(337) 419-0086

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193400000X SINGLE SPECIALTY GROUP 235Z00000X 7129 LA Primary
Hearing and Speech Clinic/Center 261QH0700X

Addresses

Primary practice location

3501 5TH Ave Ste a
Lake Charles, LA 70607-2155

Mailing address

3501 5TH Ave Ste a
Lake Charles, LA 70607-2155
Phone (337) 419-0086

Other practice location 1

1123 Paris St
Lake Charles, LA 70605-4337
Phone (337) 912-9006

Other practice location 2

852 University Dr
Lake Charles, LA 70605-6120
Phone (337) 419-0086

National Provider Directory

National Provider Directory

Locations

3501 5th Ave
Ste A
Lake Charles, LA 70607
Phone (337) 310-0153

852 University Dr
Lake Charles, LA 70605

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1466035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679443200000",
    "number": "1346690740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3501 5TH AVE STE A",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706072155",
            "telephone_number": "337-419-0086",
            "fax_number": "337-415-0626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 5TH AVE STE A",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706072155",
            "telephone_number": "337-419-0086",
            "fax_number": "337-415-0626"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1123 Paris St",
            "address_purpose": "LOCATION",
            "city": "Lake Charles",
            "state": "LA",
            "postal_code": "706054337",
            "country_code": "US",
            "telephone_number": "337-912-9006",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "852 University Dr",
            "address_purpose": "LOCATION",
            "city": "Lake Charles",
            "state": "LA",
            "postal_code": "706056120",
            "country_code": "US",
            "telephone_number": "337-419-0086",
            "fax_number": "337-415-0626",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MAGNOLIA PEDIATRIC THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-16",
        "last_updated": "2023-03-22",
        "certification_date": "2023-03-22",
        "status": "A",
        "authorized_official_last_name": "MUSSO",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_title_or_position": "MANAGER/OWNER",
        "authorized_official_telephone_number": "337-419-0086",
        "authorized_official_credential": "M.A., CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "LA",
            "license": "7129",
            "primary": true
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.