MEDICARE: MARIEL FRIEDBERG KNAUSS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	14028503	CO

General Provider Information

NPI Number	:	1093583627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIEL FRIEDBERG KNAUSS

Provider Business Mailing Address
First Line	:	33 N INSTITUTE ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-3508
Country	:	US
Telephone Number	:	724-396-4970
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 N INSTITUTE ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-3508
Country	:	US
Telephone Number	:	724-396-4970
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2023
Last Update Date	:	12/13/2023

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