Provider Demographics
NPI:1609336163
Name:MCKNIGHT, JAJUAN RAYNARD
Entity Type:Individual
Prefix:MR
First Name:JAJUAN
Middle Name:RAYNARD
Last Name:MCKNIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9705 DANWOOD LN NW APT 19
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9146
Mailing Address - Country:US
Mailing Address - Phone:803-825-1093
Mailing Address - Fax:
Practice Address - Street 1:2430 NW MYHRE RD # 101
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7669
Practice Address - Country:US
Practice Address - Phone:360-328-5054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst