MEDICARE: KNECHT AUDIOLOGY INC

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	231H00000X	Audiologist	23001969A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000370115	OTHER	IN	ANTHEM PIN NUMBER
2	1902828031	OTHER	IN	TYPE 1 NPI NUMBER

General Provider Information

NPI Number	:	1396861100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KNECHT AUDIOLOGY INC

Provider Business Mailing Address
First Line	:	2606 VETERANS MEMORIAL PKWY S
Second Line	:	STE. 1
City	:	LAFAYETTE
State	:	IN
Zip	:	47909-9192
Country	:	US
Telephone Number	:	765-474-4544
Fax Number	:	765-474-1122

Provider Business Practice Location Address
First Line	:	2606 VETERANS MEMORIAL PKWY S
Second Line	:	STE. 1
City	:	LAFAYETTE
State	:	IN
Zip	:	47909-9192
Country	:	US
Telephone Number	:	765-474-4544
Fax Number	:	765-474-1122

Authorized Official
Title or Position	:	OWNER
Name	:	GAIL RENEE KNECHT LOY
Credential	:	AUD
Telephone Number	:	765-474-4544

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	05/21/2014

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Directions to “KNECHT AUDIOLOGY INC ” Practice Location

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