Provider Demographics
NPI:1407926595
Name:KNOBLAUCH, RYAN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:KNOBLAUCH
Suffix:
Gender:M
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 1:1296 RUNNING BROOK DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1889
Mailing Address - Country:US
Mailing Address - Phone:419-740-1181
Mailing Address - Fax:
Practice Address - Street 1:27511 HOLIDAY LN
Practice Address - Street 2:STE 202C
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5397
Practice Address - Country:US
Practice Address - Phone:419-740-1181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-8278235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist