MEDICARE: HOLLY J KNABB LISW-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	943847	OH
2	1041C0700X	Clinical Social Worker	I0007502	OH

General Provider Information

NPI Number	:	1124575337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY J KNABB LISW-S

Provider Business Mailing Address
First Line	:	1929 ROCKLAND AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-1614
Country	:	US
Telephone Number	:	513-252-3217
Fax Number	:

Provider Business Practice Location Address
First Line	:	1929 ROCKLAND AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-1614
Country	:	US
Telephone Number	:	513-252-3217
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	09/06/2016

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