Provider Demographics
NPI:1710637665
Name:MCKNIGHT, MISTY A (MA SPED ABA HI)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:A
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:MA SPED ABA HI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 10TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-2119
Mailing Address - Country:US
Mailing Address - Phone:509-295-1069
Mailing Address - Fax:
Practice Address - Street 1:720 10TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2119
Practice Address - Country:US
Practice Address - Phone:509-295-1069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician