Provider Demographics
NPI:1255535100
Name:KNOLHOFF, KELLY CLARKE (AUD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:CLARKE
Last Name:KNOLHOFF
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 SAM FURR RD STE 250
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-4108
Mailing Address - Country:US
Mailing Address - Phone:704-237-4099
Mailing Address - Fax:704-237-4095
Practice Address - Street 1:8600 SAM FURR RD STE 250
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-4108
Practice Address - Country:US
Practice Address - Phone:704-237-4099
Practice Address - Fax:704-237-4095
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1296237600000X
NC7851231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412824Medicaid
NC2699601OtherMEDICARE PTAN#