Healthcare Provider Details

I. General information

NPI: 1497780332
Provider Name (Legal Business Name): WILLIAM RVEMKE KNOWLTON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10333 EL CAMINO REAL
ATASCADERO CA
93422-5808
US

IV. Provider business mailing address

10333 EL CAMINO REAL
ATASCADERO CA
93422-5808
US

V. Phone/Fax

Practice location:
  • Phone: 805-468-2000
  • Fax: 805-466-6011
Mailing address:
  • Phone: 805-468-2000
  • Fax: 805-466-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10469
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY10469
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: