Provider Demographics
NPI:1457458341
Name:KNOWLTON, LAURIE JO (LISW-S, SAP)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:JO
Last Name:KNOWLTON
Suffix:
Gender:F
Credentials:LISW-S, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20939 LORAIN RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2022
Mailing Address - Country:US
Mailing Address - Phone:440-213-3623
Mailing Address - Fax:440-331-2052
Practice Address - Street 1:20939 LORAIN RD
Practice Address - Street 2:SUITE 8
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2022
Practice Address - Country:US
Practice Address - Phone:440-213-3623
Practice Address - Fax:440-331-2052
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI101961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical