Provider Demographics
NPI:1841615747
Name:KNOBLAUCH, LINDA (MS, LAC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:KNOBLAUCH
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 N DUNCAN ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-5704
Mailing Address - Country:US
Mailing Address - Phone:316-283-7829
Mailing Address - Fax:316-262-7384
Practice Address - Street 1:1309 N DUNCAN ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-5704
Practice Address - Country:US
Practice Address - Phone:316-283-7829
Practice Address - Fax:316-283-7449
Is Sole Proprietor?:No
Enumeration Date:2014-02-28
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1125101YA0400X
KS408101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)