Provider Demographics
NPI:1366714818
Name:KNOLLHOFF, STEPHANIE MARCIA (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MARCIA
Last Name:KNOLLHOFF
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Gender:F
Credentials:MA, CCC-SLP
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Mailing Address - Street 1:1200 SUNNYSIDE AVE
Mailing Address - Street 2:2101 HAWORTH
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66045-7600
Mailing Address - Country:US
Mailing Address - Phone:785-864-4690
Mailing Address - Fax:785-864-5094
Practice Address - Street 1:1200 SUNNYSIDE AVE
Practice Address - Street 2:2101 HAWORTH
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66045-7600
Practice Address - Country:US
Practice Address - Phone:785-864-4690
Practice Address - Fax:785-864-5094
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2009019319235Z00000X
KS3563235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist