Provider Demographics
NPI:1356369664
Name:KNIELE, KATHRYN (PHD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:KNIELE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1744 SAM RITTENBERG BLVD
Mailing Address - Street 2:SUITE A3
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4935
Mailing Address - Country:US
Mailing Address - Phone:843-278-7716
Mailing Address - Fax:843-278-7716
Practice Address - Street 1:1744 SAM RITTENBERG BLVD
Practice Address - Street 2:SUITE A3
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4935
Practice Address - Country:US
Practice Address - Phone:843-278-7716
Practice Address - Fax:843-278-7716
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1026103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPS0426Medicaid