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General NPI Number Information
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NPI Number | 1336409804
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Entity Type | Organization
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Legal Business Name | JENNI KNOWLES, PH.D., LP, LLC
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Dates
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Enumeration Date | 05/18/2012
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Last Update Date | 05/18/2012
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Provider Practice Location Address
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Address Line | 200 E BIG BEAVER RD # 116
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City | TROY
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State | MI
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Zip | 48083-1208
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Country | US
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Telephone | 248-320-1196
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Fax |
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Provider Business Mailing Address
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Address Line | 6633 ELLINWOOD DR
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City | WHITE LAKE
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State | MI
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Zip | 48383-3083
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Country | US
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Telephone | 248-320-1196
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. LINDA KNOWLES
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Credential | LP
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Telephone | 248-320-1196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301014248
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License Number State | MI
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