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General NPI Number Information
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NPI Number | 1972640464
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Entity Type | Individual
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Provider Name | ELOUISE 'ELLIE' A KNUTSON MSW LICSW
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Gender | Female
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 01/31/2017
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Provider Practice Location Address
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Address Line | 1535 110TH ST SE
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City | KERKHOVEN
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State | MN
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Zip | 56252-9564
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Country | US
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Telephone | 320-220-2159
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Fax | 320-235-0099
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Provider Business Mailing Address
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Address Line | 1535 110TH ST SE
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City | KERKHOVEN
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State | MN
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Zip | 56252-9564
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Country | US
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Telephone | 320-220-2159
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Fax | 320-235-0099
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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 | 11513
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License Number State | MN
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