Basic Information
| Provider Information | |||||||||
| NPI: | 1528371226 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MAGNOLIA CONSULTING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8321 28TH ST NE | ||||||||
| Address2: | |||||||||
| City: | LAKE STEVENS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982586443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254225521 | ||||||||
| FaxNumber: | 8888744807 | ||||||||
| Practice Location | |||||||||
| Address1: | 8321 28TH ST NE | ||||||||
| Address2: | |||||||||
| City: | LAKE STEVENS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982586443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254225521 | ||||||||
| FaxNumber: | 8888744807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2010 | ||||||||
| LastUpdateDate: | 07/22/2010 | ||||||||
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| AuthorizedOfficialLastName: | PAMPINO | ||||||||
| AuthorizedOfficialFirstName: | RALPH | ||||||||
| AuthorizedOfficialMiddleName: | N. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER / BEHAVIOR ANALYST | ||||||||
| AuthorizedOfficialTelephone: | 4254225521 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MA, BCBA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1041648 | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.