Provider Demographics
NPI:1508150632
Name:KNUTSON, JENNIFER LEIGH (MSW, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEIGH
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LEIGH
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1206 W VALEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-2952
Mailing Address - Country:US
Mailing Address - Phone:509-954-9044
Mailing Address - Fax:
Practice Address - Street 1:10103 N DIVISION ST STE 109
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-2346
Practice Address - Country:US
Practice Address - Phone:509-467-1156
Practice Address - Fax:509-468-0162
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW603300311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW60330031OtherWASHINGTON STATE LICENSE