MEDICARE: KENESHA KNOX

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	104100000X	Social Worker	6851116073	MI

General Provider Information

NPI Number	:	1548982291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENESHA KNOX

Provider Business Mailing Address
First Line	:	205 N EAST AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-1753
Country	:	US
Telephone Number	:	517-205-4067
Fax Number	:	517-789-5918

Provider Business Practice Location Address
First Line	:	205 N EAST AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-1753
Country	:	US
Telephone Number	:	517-205-4067
Fax Number	:	517-789-5918

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

Provider Enumeration Date	:	09/19/2022
Last Update Date	:	12/09/2025

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Directions to “ KENESHA KNOX ” Practice Location

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