Provider Demographics
NPI:1225924392
Name:KNELLINGER, SARAH KANE
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KANE
Last Name:KNELLINGER
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 CLOQUET AVE
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-2141
Mailing Address - Country:US
Mailing Address - Phone:218-600-5303
Mailing Address - Fax:
Practice Address - Street 1:3412 BENT TROUT LAKE RD
Practice Address - Street 2:
Practice Address - City:BARNUM
Practice Address - State:MN
Practice Address - Zip Code:55707-8872
Practice Address - Country:US
Practice Address - Phone:218-879-2119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician