Provider Demographics
NPI:1972780427
Name:KNOTT, GLORIA J (MST CCC SLP)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:J
Last Name:KNOTT
Suffix:
Gender:F
Credentials:MST CCC SLP
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:J
Other - Last Name:DEISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MST CCC SLP
Mailing Address - Street 1:747 TOWER RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-8207
Mailing Address - Country:US
Mailing Address - Phone:715-426-5004
Mailing Address - Fax:
Practice Address - Street 1:2705 ENLOE ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-8173
Practice Address - Country:US
Practice Address - Phone:715-386-2128
Practice Address - Fax:715-386-6119
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI699235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN98G38KNOtherBCBS MN
HP43822OtherHEALTH PARTNERS
WI42705700Medicaid
7982224OtherAETNA
1046996OtherPREFERRED ONE
4600368OtherMEDICA