Provider Demographics
NPI:1629851373
Name:KNOLL, MICHAEL (BC-HIS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KNOLL
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 N 400 E STE 101
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-7578
Mailing Address - Country:US
Mailing Address - Phone:801-804-5000
Mailing Address - Fax:
Practice Address - Street 1:1515 N 400 E STE 101
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-7578
Practice Address - Country:US
Practice Address - Phone:801-804-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8028237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist