Healthcare Provider Details

I. General information

NPI: 1669032157
Provider Name (Legal Business Name): SUSAN E KNAPP LISW-CP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 PLANTATION PARK DR STE 202
BLUFFTON SC
29910-6072
US

IV. Provider business mailing address

380 MARSHLAND RD APT H15
HILTON HEAD ISLAND SC
29926-2122
US

V. Phone/Fax

Practice location:
  • Phone: 843-290-6828
  • Fax: 843-757-3993
Mailing address:
  • Phone: 913-221-4543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12963
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: