Healthcare Provider Details

I. General information

NPI: 1003230533
Provider Name (Legal Business Name): PHILIP KNIER M.ED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2014
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E WALDO BLVD
MANITOWOC WI
54220-2912
US

IV. Provider business mailing address

610 N 4TH ST
MANITOWOC WI
54220-3931
US

V. Phone/Fax

Practice location:
  • Phone: 920-323-2188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number372-228
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: