Provider Demographics
NPI:1003322538
Name:KNUTSON, MARLY KAY BOROVICH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARLY
Middle Name:KAY BOROVICH
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MARLY
Other - Middle Name:KAY BOROVICH
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3728
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-3728
Mailing Address - Country:US
Mailing Address - Phone:626-884-7789
Mailing Address - Fax:
Practice Address - Street 1:1005 S CAULKINS ST APT 3
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-9183
Practice Address - Country:US
Practice Address - Phone:626-884-7789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011020531041C0700X
AK1769731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801102053OtherLLMSW