Healthcare Provider Details

I. General information

NPI: 1275498305
Provider Name (Legal Business Name): JENNIFER KNOLL MA, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER WITHEY MT-BC

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3933 HARRISON ST
RIVERSIDE CA
92503-3523
US

IV. Provider business mailing address

308 N WANDA DR
FULLERTON CA
92833-2648
US

V. Phone/Fax

Practice location:
  • Phone: 833-391-0505
  • Fax: 951-358-4716
Mailing address:
  • Phone: 562-477-8989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number14561
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: