Provider Demographics
NPI:1669247557
Name:MAGAR MYOFUNCTIONAL AND SPEECH SERVICES, PLLC
Entity type:Organization
Organization Name:MAGAR MYOFUNCTIONAL AND SPEECH SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:KNUDSON-MAGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:253-569-5224
Mailing Address - Street 1:8169 VIA BOLZANO
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-5232
Mailing Address - Country:US
Mailing Address - Phone:253-569-5224
Mailing Address - Fax:
Practice Address - Street 1:8169 VIA BOLZANO
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-5232
Practice Address - Country:US
Practice Address - Phone:253-569-5224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty