Provider Demographics
NPI:1831334531
Name:KNOELL, TIMOTHY L (NBC-HIS)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:L
Last Name:KNOELL
Suffix:
Gender:M
Credentials:NBC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 SUNNYSIDE LN
Mailing Address - Street 2:P.O.BOX 462
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-2203
Mailing Address - Country:US
Mailing Address - Phone:712-243-2422
Mailing Address - Fax:
Practice Address - Street 1:1205 SUNNYSIDE LN
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-2203
Practice Address - Country:US
Practice Address - Phone:712-243-2422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00518237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist