Healthcare Provider Details

I. General information

NPI: 1437634227
Provider Name (Legal Business Name): ELIZABETH MCKNIGHT LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8440 MARKET ST
YOUNGSTOWN OH
44512-6703
US

IV. Provider business mailing address

9041 RIDGE RD
WILLIAMSFIELD OH
44093-9738
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-9999
  • Fax: 330-757-0000
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1600023
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: