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General NPI Number Information
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NPI Number | 1235411364
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Entity Type | Individual
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Provider Name | CHRISTINE MARI OLIVER-KNEEBONE LICSW
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Gender | Female
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Dates
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Enumeration Date | 09/14/2011
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Last Update Date | 09/14/2011
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Provider Practice Location Address
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Address Line | 115 7TH ST
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City | TWO HARBORS
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State | MN
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Zip | 55616-1528
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Country | US
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Telephone | 218-834-6005
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Fax | 218-834-6005
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Provider Business Mailing Address
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Address Line | 1795 HIGHWAY 2
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City | TWO HARBORS
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State | MN
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Zip | 55616-3018
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Country | US
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Telephone | 218-355-8645
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Fax | 218-834-6005
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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 | 19297
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License Number State | MN
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