Provider Demographics
NPI:1689260507
Name:KNISELY AUD, LLC
Entity Type:Organization
Organization Name:KNISELY AUD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TESSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KNISELY
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:814-937-3485
Mailing Address - Street 1:187 SLATE DR
Mailing Address - Street 2:
Mailing Address - City:EAST FREEDOM
Mailing Address - State:PA
Mailing Address - Zip Code:16637-8945
Mailing Address - Country:US
Mailing Address - Phone:814-937-3485
Mailing Address - Fax:
Practice Address - Street 1:202 MEMORIAL DR STE 3
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-7057
Practice Address - Country:US
Practice Address - Phone:814-623-5007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1034157180001Medicaid