Provider Demographics
NPI:1316379811
Name:KNOTTS, LUCI G (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LUCI
Middle Name:G
Last Name:KNOTTS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 HUCKLEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39562-2203
Mailing Address - Country:US
Mailing Address - Phone:228-623-8734
Mailing Address - Fax:
Practice Address - Street 1:7302 HIGHWAY 613 STE D
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39563-9432
Practice Address - Country:US
Practice Address - Phone:228-623-8734
Practice Address - Fax:228-460-5120
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS1068235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist