MEDICARE: MRS. STEPHANIE MARCIA KNOLLHOFF M.A., CCC-SLP

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	2009019319	MO
2	235Z00000X	Speech-Language Pathologist	3563	KS

General Provider Information

NPI Number	:	1366714818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE MARCIA KNOLLHOFF M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	1200 SUNNYSIDE AVE
Second Line	:	2101 HAWORTH
City	:	LAWRENCE
State	:	KS
Zip	:	66045-7600
Country	:	US
Telephone Number	:	785-864-4690
Fax Number	:	785-864-5094

Provider Business Practice Location Address
First Line	:	1200 SUNNYSIDE AVE
Second Line	:	2101 HAWORTH
City	:	LAWRENCE
State	:	KS
Zip	:	66045-7600
Country	:	US
Telephone Number	:	785-864-4690
Fax Number	:	785-864-5094

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

Provider Enumeration Date	:	01/30/2012
Last Update Date	:	03/31/2015

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Directions to “ MRS. STEPHANIE MARCIA KNOLLHOFF M.A., CCC-SLP” Practice Location

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