Provider Demographics
NPI:1003103144
Name:MCKNIGHT, TIA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9120 LENOX POINTE DR
Mailing Address - Street 2:APT. 206
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-5937
Mailing Address - Country:US
Mailing Address - Phone:931-205-7669
Mailing Address - Fax:
Practice Address - Street 1:9120 LENOX POINTE DR
Practice Address - Street 2:APT. 206
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-5937
Practice Address - Country:US
Practice Address - Phone:931-205-7669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2915235Z00000X
NC7335235Z00000X
SC4795235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist