MEDICARE: JOHN KNUTH

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1669161303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN KNUTH

Provider Business Mailing Address
First Line	:	421 JACKSON ST
Second Line	:
City	:	SHEBOYGAN FALLS
State	:	WI
Zip	:	53085-1459
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	421 JACKSON ST
Second Line	:
City	:	SHEBOYGAN FALLS
State	:	WI
Zip	:	53085-1459
Country	:	US
Telephone Number	:	920-838-0728
Fax Number	:

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

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	05/08/2023

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Directions to “ JOHN KNUTH ” Practice Location

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