Provider Demographics
NPI:1306607361
Name:KNISLEY, HANNAH (ACLC, SWLC)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:KNISLEY
Suffix:
Gender:F
Credentials:ACLC, SWLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 3RD ST W UNIT B
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-3053
Mailing Address - Country:US
Mailing Address - Phone:814-441-7718
Mailing Address - Fax:
Practice Address - Street 1:9549 US HIGHWAY 2E
Practice Address - Street 2:
Practice Address - City:HUNGARY HORSE
Practice Address - State:MT
Practice Address - Zip Code:59919
Practice Address - Country:US
Practice Address - Phone:406-607-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT63746101YA0400X
MT642231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)