Provider Demographics
NPI:1063476687
Name:KNAPP, JANE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:KNAPP
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:HEESEN
Other - Last Name:DIETRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2680 BAYSHORE PARKWAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-4425
Mailing Address - Country:US
Mailing Address - Phone:650-288-6069
Mailing Address - Fax:
Practice Address - Street 1:2680 BAYSHORE PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-1018
Practice Address - Country:US
Practice Address - Phone:650-288-6069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007834L103T00000X
CAPSY28448103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01761330Medicaid
PA01761330Medicaid