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General NPI Number Information
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NPI Number | 1316379811
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Entity Type | Individual
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Provider Name | LUCI G KNOTTS CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/07/2013
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Last Update Date | 08/05/2019
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Provider Practice Location Address
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Address Line | 7302 HIGHWAY 613 STE D
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City | MOSS POINT
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State | MS
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Zip | 39563-9432
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Country | US
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Telephone | 228-623-8734
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Fax | 228-460-5120
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Provider Business Mailing Address
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Address Line | 5210 HUCKLEBERRY LN
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City | MOSS POINT
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State | MS
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Zip | 39562-2203
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Country | US
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Telephone | 228-623-8734
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | S1068
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License Number State | MS
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