Doctor Name: | DR. GLENN E. KNOWLTON |
NPI Number: | 1063482297 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | 210 |
Business Practice Address: | 1401 13th Ave E West Fargo, ND - 580783468 |
Business Phone Number: | 7013640060 |
Business Fax Number: | 7013640065 |
Mailing Address: | 1401 13th Ave E, WEST FARGO |
State: | ND |
Postal Code: | 580783468 |
Phone Number: | 7013640060 |
Fax Number: | 7013640065 |
NPI Enumeration Date: | 01/23/2006 |
NPI Last Update Date: | 01/29/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 210 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ND |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |