Healthcare Provider Details

I. General information

NPI: 1538834775
Provider Name (Legal Business Name): MICHAEL BLAINE KNAPP LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 S BURDICK ST
KALAMAZOO MI
49007-5221
US

IV. Provider business mailing address

610 S BURDICK ST
KALAMAZOO MI
49007-5221
US

V. Phone/Fax

Practice location:
  • Phone: 269-762-1653
  • Fax: 269-364-6992
Mailing address:
  • Phone: 269-762-1653
  • Fax: 269-364-6992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851107506
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: