Healthcare Provider Details

I. General information

NPI: 1134991532
Provider Name (Legal Business Name): EMILY ELIZABETH KNUTSON CD,CLC, CRM.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 ABBEY LN # 104
ASTORIA OR
97103-2237
US

IV. Provider business mailing address

92700 MAGGIE JOHNSON RD
ASTORIA OR
97103-8629
US

V. Phone/Fax

Practice location:
  • Phone: 360-442-6782
  • Fax:
Mailing address:
  • Phone: 360-442-6782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number111714
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number111714
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number111714
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: