Healthcare Provider Details

I. General information

NPI: 1356592653
Provider Name (Legal Business Name): SUSAN C KNIGHT-ALLEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19185 SW 90TH AVENUE TUALATIN CLINIC
TUALATIN OR
97062
US

IV. Provider business mailing address

3640 NE BRYCE ST
PORTLAND OR
97212-1857
US

V. Phone/Fax

Practice location:
  • Phone: 503-885-7329
  • Fax: 503-885-7377
Mailing address:
  • Phone: 503-287-9663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL3412
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: