Provider Demographics
NPI:1407872815
Name:KNEE, DIANA L V (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:L V
Last Name:KNEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1991 RIDGE WATER DR
Mailing Address - Street 2:
Mailing Address - City:SUTHERLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97479-9735
Mailing Address - Country:US
Mailing Address - Phone:541-459-0247
Mailing Address - Fax:
Practice Address - Street 1:1445 GATEWAY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-1224
Practice Address - Country:US
Practice Address - Phone:541-942-0040
Practice Address - Fax:541-942-0040
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL30151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical