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Individual

MRS. PHYLLIS JEAN MAGELKY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.S. CCC-SLP

Contact information

Practice address
1112 NODAK DR S STE 135, FARGO, ND 58103-8744
(701) 364-9070
(701) 364-9071
Mailing address
3309 FIECHTNER DR S STE D, FARGO, ND 58103-2375
(701) 364-9070
(701) 364-9071

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
320
ND
235Z00000X
Speech-Language Pathologist
5882
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1033438
PREFERRED ONE
MN
01
11674
BLUE CROSS BLUE SHIELD
ND
01
27397
BLUE CROSS BLUE SHIELD
ND
05
4043140-00
MN
05
58789
ND
01
5G158N-MA
BLUE CROSS/BLUE SHIELD
MN
Enumeration date
08/31/2006
Last updated
10/22/2009
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