Provider Demographics
NPI:1114126083
Name:MCKNIGHT, SCOTT WAYNE (LLMSW, MSW)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:WAYNE
Last Name:MCKNIGHT
Suffix:
Gender:M
Credentials:LLMSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 MONROE AVE NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1452
Mailing Address - Country:US
Mailing Address - Phone:616-916-3711
Mailing Address - Fax:616-825-6015
Practice Address - Street 1:648 MONROE AVE NW
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1452
Practice Address - Country:US
Practice Address - Phone:616-916-3711
Practice Address - Fax:616-825-6015
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010891821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical