Provider Demographics
NPI:1356652150
Name:KNOTTS, CASEY (MA CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:
Last Name:KNOTTS
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 1:638 BOONER MILLER ROAD
Mailing Address - Street 2:
Mailing Address - City:DEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71328
Mailing Address - Country:US
Mailing Address - Phone:318-560-6250
Mailing Address - Fax:
Practice Address - Street 1:638 BOONER MILLER ROAD
Practice Address - Street 2:
Practice Address - City:DEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71328
Practice Address - Country:US
Practice Address - Phone:318-560-6250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6126235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist