Healthcare Provider Details

I. General information

NPI: 1962650721
Provider Name (Legal Business Name): LORI KNAPP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S MARQUETTE RD
PRAIRIE DU CHIEN WI
53821-2414
US

IV. Provider business mailing address

1100 S MARQUETTE RD
PRAIRIE DU CHIEN WI
53821-2414
US

V. Phone/Fax

Practice location:
  • Phone: 608-326-5536
  • Fax: 608-326-4255
Mailing address:
  • Phone: 608-326-5536
  • Fax: 608-326-4255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TAMI L WEDGEWORTH
Title or Position: COO
Credential:
Phone: 608-326-5536