Provider Demographics
NPI:1174867261
Name:KNOLES, VIRGINIA INEZ
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:INEZ
Last Name:KNOLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 CASTLEMAN DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-4615
Mailing Address - Country:US
Mailing Address - Phone:360-430-3715
Mailing Address - Fax:
Practice Address - Street 1:2210 OLYMPIA WAY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4505
Practice Address - Country:US
Practice Address - Phone:360-501-8706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant