Healthcare Provider Details

I. General information

NPI: 1497296461
Provider Name (Legal Business Name): RYAN D KNUTSON CSAC, LPC, ICS-IT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2017
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 BRAUND ST
ONALASKA WI
54650
US

IV. Provider business mailing address

1333 TRAVIS ST
LA CROSSE WI
54601-6343
US

V. Phone/Fax

Practice location:
  • Phone: 608-785-7000
  • Fax: 608-785-7477
Mailing address:
  • Phone: 608-386-6080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16064
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2777
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: