Provider Demographics
NPI:1255601431
Name:KNEBEL, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:KNEBEL
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 1:601A STALLARD ST
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:IL
Mailing Address - Zip Code:62275-3034
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601A STALLARD ST
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:IL
Practice Address - Zip Code:62275-3034
Practice Address - Country:US
Practice Address - Phone:618-669-2636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant