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General NPI Number Information
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NPI Number | 1538198759
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Entity Type | Organization
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Legal Business Name | KNOWLTON, O'NEILL & ASSOCIATES, P.C.
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 1401 13TH AVE E
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City | WEST FARGO
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State | ND
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Zip | 58078-3468
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Country | US
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Telephone | 701-364-0060
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Fax | 701-364-0065
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Provider Business Mailing Address
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Address Line | 1401 13TH AVE E
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City | WEST FARGO
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State | ND
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Zip | 58078-3468
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Country | US
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Telephone | 701-364-0060
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Fax | 701-364-0065
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Authorized Official
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Title or Position | PRESIDENT/CLINICAL PSYCHOLOGIST
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Name | HOLLY HEGSTAD
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Credential | PHD
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Telephone | 701-364-0060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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