Provider Demographics
NPI:1952017071
Name:KNALY, KATIE RAE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:RAE
Last Name:KNALY
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 1:9358 CALVARY CIR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-2084
Mailing Address - Country:US
Mailing Address - Phone:443-783-5478
Mailing Address - Fax:
Practice Address - Street 1:2424 NORTHGATE DR STE 100
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7888
Practice Address - Country:US
Practice Address - Phone:410-677-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02641L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty