Healthcare Provider Details

I. General information

NPI: 1154533446
Provider Name (Legal Business Name): JOAN MARIE KNOCKEL LCMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 JOHN F KENNEDY RD ASBURY SQUARE
DUBUQUE IA
52002-2846
US

IV. Provider business mailing address

2255 JOHN F KENNEDY RD ASBURY SQUARE
DUBUQUE IA
52002-2846
US

V. Phone/Fax

Practice location:
  • Phone: 563-583-3629
  • Fax:
Mailing address:
  • Phone: 563-583-3629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number43
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: