Provider Demographics
NPI:1780729079
Name:BOE-KNOLL, LAURA ELIZABETH (AUD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ELIZABETH
Last Name:BOE-KNOLL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ELIZABETH
Other - Last Name:BOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:462 W. HAF DAY ROAD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6555
Mailing Address - Country:US
Mailing Address - Phone:847-276-2735
Mailing Address - Fax:847-276-2733
Practice Address - Street 1:462 W. HAF DAY ROAD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6555
Practice Address - Country:US
Practice Address - Phone:847-276-2735
Practice Address - Fax:847-276-2733
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-001399231HA2400X, 237600000X, 237600000X
IL147001399231HA2500X, 231HA2500X
IL174-001399231H00000X
CAAU2417231HA2500X, 237700000X
CAAU 2417237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist