Provider Demographics
NPI:1679010847
Name:JENNIFER MARIE MCKNIGHT
Entity Type:Organization
Organization Name:JENNIFER MARIE MCKNIGHT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCKNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:CDCA
Authorized Official - Phone:440-282-1800
Mailing Address - Street 1:3746 PROSPECT AVE E
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2706
Mailing Address - Country:US
Mailing Address - Phone:440-282-1800
Mailing Address - Fax:440-348-2383
Practice Address - Street 1:3746 PROSPECT AVE E
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2706
Practice Address - Country:US
Practice Address - Phone:440-282-1800
Practice Address - Fax:440-348-2383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health