Provider Demographics
NPI:1174183545
Name:KNUTSEN, MARCIA KAY
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:KAY
Last Name:KNUTSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 S FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-2663
Mailing Address - Country:US
Mailing Address - Phone:608-728-4358
Mailing Address - Fax:
Practice Address - Street 1:60 S FREMONT ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-2663
Practice Address - Country:US
Practice Address - Phone:608-728-4358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor