Provider Demographics
NPI:1841409844
Name:KNORR, GERALYNN S
Entity Type:Individual
Prefix:
First Name:GERALYNN
Middle Name:S
Last Name:KNORR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11103 FAIRBANKS WAY
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4946
Mailing Address - Country:US
Mailing Address - Phone:310-880-5504
Mailing Address - Fax:
Practice Address - Street 1:11103 FAIRBANKS WAY
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4946
Practice Address - Country:US
Practice Address - Phone:310-880-5504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5009235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ26078ZOtherBLUE SHIELD OF CA PIN