Healthcare Provider Details

I. General information

NPI: 1053236232
Provider Name (Legal Business Name): LINDA SUE KNOWLTON ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 GLENDALE AVENUE, OTTAWA OHIO 45875
OTTAWA OH
45875
US

IV. Provider business mailing address

630 GLENDALE AVENUE, OTTAWA OHIO 45875
OTTAWA OH
45875
US

V. Phone/Fax

Practice location:
  • Phone: 419-523-5261
  • Fax:
Mailing address:
  • Phone: 419-523-5261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP01411
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: