Provider Demographics
NPI:1679707830
Name:VICKERS KNIGHT, ISABELLA (MA)
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:
Last Name:VICKERS KNIGHT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 SW MADISON AVE
Mailing Address - Street 2:SUITE J-4
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4799
Mailing Address - Country:US
Mailing Address - Phone:541-207-5077
Mailing Address - Fax:
Practice Address - Street 1:425 SW MADISON AVE
Practice Address - Street 2:SUITE J-4
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4799
Practice Address - Country:US
Practice Address - Phone:541-207-5077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-03
Last Update Date:2009-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR1459101YM0800X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)