Provider Demographics
NPI:1295080380
Name:KNOTTS, LEIGH (PSYD)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:KNOTTS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:
Other - Last Name:HUELSKAMP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11491 NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:GRANTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21536-2016
Mailing Address - Country:US
Mailing Address - Phone:301-500-0250
Mailing Address - Fax:
Practice Address - Street 1:32 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:GRANTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21536-1259
Practice Address - Country:US
Practice Address - Phone:301-895-8750
Practice Address - Fax:301-895-8751
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03740103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD03WWMedicare UPIN