Provider Demographics
NPI:1790019834
Name:KNISELEY, JAMES (MS CCC, SLP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:KNISELEY
Suffix:
Gender:M
Credentials:MS CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 OAKTON CT #10C
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7835
Mailing Address - Country:US
Mailing Address - Phone:561-889-5809
Mailing Address - Fax:
Practice Address - Street 1:8110 OAKTON CT # 10C
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-8460
Practice Address - Country:US
Practice Address - Phone:561-889-5809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6851235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001958000Medicaid