Provider Demographics
NPI:1881629681
Name:KNUDSEN, ELAINE BROWN (LCSW)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:BROWN
Last Name:KNUDSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 W 200 N
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4505
Mailing Address - Country:US
Mailing Address - Phone:435-634-5600
Mailing Address - Fax:435-986-8702
Practice Address - Street 1:445 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KANAB
Practice Address - State:UT
Practice Address - Zip Code:84741-3250
Practice Address - Country:US
Practice Address - Phone:435-644-4520
Practice Address - Fax:435-644-4524
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT500563735011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT942938348EKNOtherEDUCATORS MUTUAL
UT107046494101OtherSELECT HEALTH