Provider Demographics
NPI:1942348800
Name:KNUPP, DIANCE T (CCC,SPL)
Entity Type:Individual
Prefix:
First Name:DIANCE
Middle Name:T
Last Name:KNUPP
Suffix:
Gender:F
Credentials:CCC,SPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 WASHINGTON AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-5347
Mailing Address - Country:US
Mailing Address - Phone:518-456-7831
Mailing Address - Fax:518-456-1563
Practice Address - Street 1:180 WASHINGTON AVENUE EXT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5347
Practice Address - Country:US
Practice Address - Phone:518-456-7831
Practice Address - Fax:518-456-1563
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002686-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10001083OtherCDPHP
NY000491034001OtherBS OF NENY
NY00310361Medicaid
NY10001083OtherCDPHP