Provider Demographics
NPI:1497007264
Name:KNIGHT, MARY SUE (MCD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUE
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:SUE
Other - Last Name:BALDRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MCD, CCC-SLP
Mailing Address - Street 1:13970 WOODLAND RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2733
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9541 BROOKLINE AVE STE D
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1591
Practice Address - Country:US
Practice Address - Phone:225-248-0477
Practice Address - Fax:225-248-0557
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3408235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist