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General NPI Number Information
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NPI Number | 1578058806
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Entity Type | Organization
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Legal Business Name | SOUTH LAKE AUDIOLOGY, INC.
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Dates
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Enumeration Date | 06/28/2018
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 8936 N POINTE EXECUTIVE PARK DR STE 195
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-0811
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Country | US
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Telephone | 704-237-4099
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Fax | 704-237-4095
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Provider Business Mailing Address
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Address Line | 8936 N POINTE EXECUTIVE PARK DR STE 195
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-0811
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Country | US
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Telephone | 704-237-4099
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Fax | 704-237-4095
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Authorized Official
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Title or Position | OWNER/AUDIOLOGIST
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Name | DR. KELLY CLARKE KNOLHOFF
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Credential | AUD
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Telephone | 704-237-4099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 7851
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License Number State | NC
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