Provider Demographics
NPI:1750310512
Name:KNEEBONE, TODD E (LICSW)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:E
Last Name:KNEEBONE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55806-2053
Mailing Address - Country:US
Mailing Address - Phone:218-722-1351
Mailing Address - Fax:218-727-0875
Practice Address - Street 1:2024 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55806-2053
Practice Address - Country:US
Practice Address - Phone:218-722-1351
Practice Address - Fax:218-727-0875
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical