Provider Demographics
NPI:1053867564
Name:KNOBLAUCH, JOELLE LYNN (MA)
Entity Type:Individual
Prefix:MRS
First Name:JOELLE
Middle Name:LYNN
Last Name:KNOBLAUCH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8045
Mailing Address - Country:US
Mailing Address - Phone:740-653-3193
Mailing Address - Fax:
Practice Address - Street 1:955 LIBERTY DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8045
Practice Address - Country:US
Practice Address - Phone:740-653-3193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2017077235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist