Healthcare Provider Details

I. General information

NPI: 1760300404
Provider Name (Legal Business Name): JENNIFER KNOTTS LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 DELAWARE AVE STE 102
MARION OH
43302-7462
US

IV. Provider business mailing address

1199 DELAWARE AVE STE 102
MARION OH
43302-7462
US

V. Phone/Fax

Practice location:
  • Phone: 220-201-1646
  • Fax: 220-201-1647
Mailing address:
  • Phone: 220-201-1646
  • Fax: 220-201-1647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0029326
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: