Provider Demographics
NPI:1205961273
Name:MCKNIGHT, KELLI (MED)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:962 MISTLETOE LOOP N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-4307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1255 PEARL ST
Practice Address - Street 2:SUITE 102
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3570
Practice Address - Country:US
Practice Address - Phone:503-910-3701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor