Healthcare Provider Details

I. General information

NPI: 1518887223
Provider Name (Legal Business Name): MYLEIGH KNUTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 E PLUM ST
MOSES LAKE WA
98837-1874
US

IV. Provider business mailing address

840 E PLUM ST
MOSES LAKE WA
98837-1874
US

V. Phone/Fax

Practice location:
  • Phone: 509-765-9239
  • Fax:
Mailing address:
  • Phone: 509-765-9239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDPT.CO.61626548
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: