Provider Demographics
NPI:1245714716
Name:KNISLEY, PATRICK (MA, SLP)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:KNISLEY
Suffix:
Gender:M
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 W 117TH ST
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2241
Mailing Address - Country:US
Mailing Address - Phone:310-838-1552
Mailing Address - Fax:
Practice Address - Street 1:4455 W 117TH ST
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2241
Practice Address - Country:US
Practice Address - Phone:310-838-1552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1942530407OtherMULTI-SPECIALTY GROUP