Healthcare Provider Details

I. General information

NPI: 1457904542
Provider Name (Legal Business Name): JENNIFER KNAACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 MARION BLVD
MARION IA
52302-3135
US

IV. Provider business mailing address

2923 JAMES PKWY SW
CEDAR RAPIDS IA
52404-7171
US

V. Phone/Fax

Practice location:
  • Phone: 319-363-2678
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number00118889
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: