Provider Demographics
NPI:1841954484
Name:KNOEPFFLER, BRENDA IVELISSE
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:IVELISSE
Last Name:KNOEPFFLER
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 1:1302 KEEFER RD
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4224
Mailing Address - Country:US
Mailing Address - Phone:281-357-3140
Mailing Address - Fax:
Practice Address - Street 1:1302 KEEFER RD
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4224
Practice Address - Country:US
Practice Address - Phone:281-357-3140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104298235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist