Provider Demographics
NPI:1144422882
Name:KNOWLES, RODNEY LAMAR (MS)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:LAMAR
Last Name:KNOWLES
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-4018
Mailing Address - Country:US
Mailing Address - Phone:218-821-3556
Mailing Address - Fax:218-829-4269
Practice Address - Street 1:723 S 5TH ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-4018
Practice Address - Country:US
Practice Address - Phone:218-821-3556
Practice Address - Fax:218-829-4269
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00493101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional