Provider Demographics
NPI:1093001703
Name:KNUTSON, BRETT (SAC-IT, PC-T)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:KNUTSON
Suffix:
Gender:M
Credentials:SAC-IT, PC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 MAIN ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-3261
Mailing Address - Country:US
Mailing Address - Phone:608-386-6154
Mailing Address - Fax:
Practice Address - Street 1:444 MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-3261
Practice Address - Country:US
Practice Address - Phone:608-386-6154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16304-130101YA0400X
WI5317-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)