Provider Demographics
NPI:1871751131
Name:KNOTT, KERRY JANE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:JANE
Last Name:KNOTT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-4058
Mailing Address - Country:US
Mailing Address - Phone:360-270-9977
Mailing Address - Fax:
Practice Address - Street 1:1115 CAPITOLA RD
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2844
Practice Address - Country:US
Practice Address - Phone:831-475-4055
Practice Address - Fax:831-475-4987
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 14311235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist