Provider Demographics
NPI:1114216124
Name:KNOELL, CYNTHIA LEE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LEE
Last Name:KNOELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:LEE
Other - Last Name:BRUNETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:315 GARFIELD AVE S
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:MN
Mailing Address - Zip Code:55363-8534
Mailing Address - Country:US
Mailing Address - Phone:612-715-0513
Mailing Address - Fax:612-715-0513
Practice Address - Street 1:315 GARFIELD AVE S
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:MN
Practice Address - Zip Code:55363-8534
Practice Address - Country:US
Practice Address - Phone:612-715-0513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2022-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN147431041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical