Healthcare Provider Details

I. General information

NPI: 1437623402
Provider Name (Legal Business Name): KIMBERLY LYNN KNOWLTON M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 FOX HILL DR
NATICK MA
01760-1413
US

IV. Provider business mailing address

13 FOX HILL DR
NATICK MA
01760-1413
US

V. Phone/Fax

Practice location:
  • Phone: 508-478-6888
  • Fax: 508-478-9042
Mailing address:
  • Phone: 508-478-6888
  • Fax: 508-478-9042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10005229
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number520566
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: