Provider Demographics
NPI:1609762301
Name:KNOCKE, GRACE M (SAC)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:M
Last Name:KNOCKE
Suffix:
Gender:F
Credentials:SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4433 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53531-9104
Mailing Address - Country:US
Mailing Address - Phone:608-422-1045
Mailing Address - Fax:
Practice Address - Street 1:2914 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-4047
Practice Address - Country:US
Practice Address - Phone:608-223-3311
Practice Address - Fax:608-204-8585
Is Sole Proprietor?:No
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17203-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)