Provider Demographics
NPI:1629219779
Name:KNIGHT, ANDREW M (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3139 N LINCOLN AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3114
Mailing Address - Country:US
Mailing Address - Phone:773-525-4900
Mailing Address - Fax:773-525-4900
Practice Address - Street 1:3139 N LINCOLN AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3114
Practice Address - Country:US
Practice Address - Phone:773-525-4900
Practice Address - Fax:773-525-4900
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007490103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical