Provider Demographics
NPI:1770851867
Name:KNAPP, ELISE RALSTON (MSW, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ELISE
Middle Name:RALSTON
Last Name:KNAPP
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 OLD WEST MAIN STREET, SUITE 300
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-1987
Mailing Address - Country:US
Mailing Address - Phone:651-764-0911
Mailing Address - Fax:651-327-2082
Practice Address - Street 1:2000 OLD WEST MAIN STREET, SUITE 300
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-1987
Practice Address - Country:US
Practice Address - Phone:651-764-0911
Practice Address - Fax:651-327-2082
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MN215121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker