Provider Demographics
NPI:1619354636
Name:KNOWLTON-PATHEAL, MELISSA A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:A
Last Name:KNOWLTON-PATHEAL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:KNOWLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:100 N MORAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2905
Mailing Address - Country:US
Mailing Address - Phone:509-543-7253
Mailing Address - Fax:509-735-8535
Practice Address - Street 1:100 N MORAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2905
Practice Address - Country:US
Practice Address - Phone:509-543-7253
Practice Address - Fax:509-735-8535
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60472709103TC0700X
AZ4062103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical