Provider Demographics
NPI:1447301957
Name:KNOX, ROBERTA (MS)
Entity type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:
Last Name:KNOX
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-6646
Mailing Address - Country:US
Mailing Address - Phone:630-690-6186
Mailing Address - Fax:
Practice Address - Street 1:1014 E ELM ST
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-6646
Practice Address - Country:US
Practice Address - Phone:630-690-6186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232981OtherBLUE CROSS BLUE SHIELD