Healthcare Provider Details

I. General information

NPI: 1902470875
Provider Name (Legal Business Name): KOMONIQUE LATRELL KNIGHTEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2021
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

758 ROYAL ST
BATON ROUGE LA
70802-6433
US

IV. Provider business mailing address

3522 WARREN DR
BATON ROUGE LA
70814-4060
US

V. Phone/Fax

Practice location:
  • Phone: 225-529-3890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number125505
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: