Provider Demographics
NPI:1760981740
Name:MAGNOLIA PSYCHOLOGICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:MAGNOLIA PSYCHOLOGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNUTH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:630-534-3122
Mailing Address - Street 1:PO BOX 402
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-0402
Mailing Address - Country:US
Mailing Address - Phone:630-534-3122
Mailing Address - Fax:
Practice Address - Street 1:2530 CRAWFORD AVE STE 203
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4959
Practice Address - Country:US
Practice Address - Phone:630-534-3122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty