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Organization
MAGNOLIA PEDIATRIC THERAPY, LLC
Active
Organization
MAGNOLIA PEDIATRIC THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MEGAN MUSSO M.A., CCC-SLP (MANAGER/OWNER)
(337) 419-0086
Entity
Organization
Contact information
Practice address
3501 5TH AVE STE A, LAKE CHARLES, LA 70607-2155
(337) 419-0086
(337) 415-0626
Mailing address
3501 5TH AVE STE A, LAKE CHARLES, LA 70607-2155
(337) 419-0086
(337) 415-0626
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7129
LA
261QH0700X
Hearing and Speech Clinic/Center
—
—
Other
Enumeration date
06/16/2016
Last updated
03/22/2023
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