MEDICARE: MISS KENDALL RUTH KNOWLES MA, PLPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	9037	LA

General Provider Information

NPI Number	:	1124721949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KENDALL RUTH KNOWLES MA, PLPC

Provider Business Mailing Address
First Line	:	2750 LAKE VILLA DR STE 301
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70002-6710
Country	:	US
Telephone Number	:	504-635-7162
Fax Number	:

Provider Business Practice Location Address
First Line	:	2750 LAKE VILLA DR STE 301
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70002-6710
Country	:	US
Telephone Number	:	504-635-7162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2023
Last Update Date	:	03/22/2023

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