Provider Demographics
NPI:1356474803
Name:KNIES, NANCY MAUREEN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:MAUREEN
Last Name:KNIES
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 1:1791 RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-8444
Mailing Address - Country:US
Mailing Address - Phone:812-482-5987
Mailing Address - Fax:812-482-5987
Practice Address - Street 1:1791 RAYMOND ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-8444
Practice Address - Country:US
Practice Address - Phone:812-482-5987
Practice Address - Fax:812-482-5987
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003642A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist