Provider Demographics
NPI:1881912384
Name:KNIES, JANELEL LOUISE (MSCCCSLP)
Entity type:Individual
Prefix:MS
First Name:JANELEL
Middle Name:LOUISE
Last Name:KNIES
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 N LELAND DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47542-9348
Mailing Address - Country:US
Mailing Address - Phone:812-638-4090
Mailing Address - Fax:
Practice Address - Street 1:1712 N LELAND DR
Practice Address - Street 2:
Practice Address - City:HUNTINGBURG
Practice Address - State:IN
Practice Address - Zip Code:47542-9348
Practice Address - Country:US
Practice Address - Phone:812-638-4090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12122119235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12122119OtherSPEECH THERAPIST