MEDICARE: MS. KELSI ALYSSA KNICK LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C005429	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083738777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELSI ALYSSA KNICK LCSW

Provider Business Mailing Address
First Line	:	2525 VALLEY HAVEN DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-3303
Country	:	US
Telephone Number	:	919-602-1034
Fax Number	:

Provider Business Practice Location Address
First Line	:	3948 BROWNING PL
Second Line	:	SUITE 200
City	:	RALEIGH
State	:	NC
Zip	:	27609-6510
Country	:	US
Telephone Number	:	919-782-8730
Fax Number	:	919-872-8731

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/09/2007

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