Healthcare Provider Details

I. General information

NPI: 1548753916
Provider Name (Legal Business Name): ZACHARY BENNETT KNIGHT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E BROADWAY STE 415
EUGENE OR
97401-3155
US

IV. Provider business mailing address

132 E BROADWAY STE 415
EUGENE OR
97401-3155
US

V. Phone/Fax

Practice location:
  • Phone: 541-579-8760
  • Fax: 541-246-3053
Mailing address:
  • Phone: 541-579-8760
  • Fax: 541-246-3053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier500746747
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 2
Identifier500740231
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: