Provider Demographics
NPI:1629379714
Name:KNOWLTON, ANDREA B (MSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:B
Last Name:KNOWLTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:B
Other - Last Name:AUSTRENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:325 E H ST
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-4760
Mailing Address - Country:US
Mailing Address - Phone:906-774-3300
Mailing Address - Fax:
Practice Address - Street 1:1110 10TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:MENOMINEE
Practice Address - State:MI
Practice Address - Zip Code:49858-3058
Practice Address - Country:US
Practice Address - Phone:906-863-1286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker