Provider Demographics
NPI:1003103144
Name:MCKNIGHT, TIA ANITRA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:ANITRA
Last Name:MCKNIGHT
Suffix:
Gender:
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 1:929 AZURINE CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-9326
Mailing Address - Country:US
Mailing Address - Phone:931-205-7669
Mailing Address - Fax:
Practice Address - Street 1:929 AZURINE CIR
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-9326
Practice Address - Country:US
Practice Address - Phone:931-205-7669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2915235Z00000X
SC4795235Z00000X
NC7335235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist