Provider Demographics
NPI:1245558436
Name:KNAUF, TRACIE LYNN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:LYNN
Last Name:KNAUF
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 CRESCENT CIR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-4772
Mailing Address - Country:US
Mailing Address - Phone:678-462-1342
Mailing Address - Fax:678-493-9464
Practice Address - Street 1:341 CREEKSTONE RDG
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3745
Practice Address - Country:US
Practice Address - Phone:678-462-1342
Practice Address - Fax:678-493-9464
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP003451235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist