Provider Demographics
NPI:1295908168
Name:KNIGHTON, ROGER TOLMAN JR (MNS CCC-A)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:TOLMAN
Last Name:KNIGHTON
Suffix:JR
Gender:M
Credentials:MNS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 W COMSTOCK DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5805
Mailing Address - Country:US
Mailing Address - Phone:480-969-3775
Mailing Address - Fax:
Practice Address - Street 1:2600 E SOUTHERN AVE
Practice Address - Street 2:STE J2
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7610
Practice Address - Country:US
Practice Address - Phone:480-969-3775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA1303231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist