MEDICARE: MRS. VIRGINIA INEZ KNOLES

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	2355S0801X	Speech-Language Assistant

General Provider Information

NPI Number	:	1174867261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VIRGINIA INEZ KNOLES

Provider Business Mailing Address
First Line	:	902 CASTLEMAN DR
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-4615
Country	:	US
Telephone Number	:	360-430-3715
Fax Number	:

Provider Business Practice Location Address
First Line	:	2210 OLYMPIA WAY
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-4505
Country	:	US
Telephone Number	:	360-501-8706
Fax Number	:

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

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/15/2012

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Directions to “ MRS. VIRGINIA INEZ KNOLES ” Practice Location

Language	Start Address	Practice Location

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