Provider Demographics
NPI:1548755028
Name:KNIGHT, STACY RENAE (MA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:RENAE
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:RENAE
Other - Last Name:IPPOLITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:600 LAKEWAY DR
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5236
Mailing Address - Country:US
Mailing Address - Phone:360-676-6749
Mailing Address - Fax:360-738-2451
Practice Address - Street 1:600 LAKEWAY DR
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5236
Practice Address - Country:US
Practice Address - Phone:360-676-6749
Practice Address - Fax:360-738-2451
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61123477101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health