Provider Demographics
NPI:1649575853
Name:KNIGHT, JOHN WALTER (LISW-S)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WALTER
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 MONTGOMERY RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3255
Mailing Address - Country:US
Mailing Address - Phone:513-385-9600
Mailing Address - Fax:513-385-3771
Practice Address - Street 1:10700 MONTGOMERY RD
Practice Address - Street 2:SUITE 206
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-3255
Practice Address - Country:US
Practice Address - Phone:513-385-9600
Practice Address - Fax:513-385-3771
Is Sole Proprietor?:No
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0009079-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01274Medicaid