Basic Information
| Provider Information | |||||||||
| NPI: | 1548546781 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KNOLES | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | LSCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22214 D ST | ||||||||
| Address2: | STROTHER FIELD | ||||||||
| City: | WINFIELD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671567376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202219664 | ||||||||
| FaxNumber: | 6202211983 | ||||||||
| Practice Location | |||||||||
| Address1: | 22214 D ST | ||||||||
| Address2: | STROTHER FIELD | ||||||||
| City: | WINFIELD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671567376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202219664 | ||||||||
| FaxNumber: | 6202211983 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2011 | ||||||||
| LastUpdateDate: | 11/16/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | LMSW 3975 | KS | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 4607 | KS | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.