Provider Demographics
NPI:1740433234
Name:KNOWLTON, DARRELL (MSW)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:
Last Name:KNOWLTON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-5238
Mailing Address - Country:US
Mailing Address - Phone:219-879-0676
Mailing Address - Fax:
Practice Address - Street 1:414 BUTLER ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-5238
Practice Address - Country:US
Practice Address - Phone:219-879-0676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker