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General NPI Number Information
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NPI Number | 1053652362
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Entity Type | Individual
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Provider Name | KRAIG JERALD KNUDSEN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/12/2013
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Last Update Date | 03/12/2013
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Provider Practice Location Address
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Address Line | 7612 PLACID AVE
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City | COLUMBUS
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State | OH
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Zip | 43085-1541
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Country | US
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Telephone | 614-929-4195
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Fax |
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Provider Business Mailing Address
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Address Line | 7612 PLACID AVE
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City | COLUMBUS
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State | OH
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Zip | 43085-1541
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Country | US
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Telephone | 614-929-4195
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.1201589
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License Number State | OH
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