Provider Demographics
NPI:1457576779
Name:KNOTTS, JOSEPH WALTER (SACIT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WALTER
Last Name:KNOTTS
Suffix:
Gender:M
Credentials:SACIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 E 2ND ST
Mailing Address - Street 2:APT. 8
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-3578
Mailing Address - Country:US
Mailing Address - Phone:715-718-0013
Mailing Address - Fax:
Practice Address - Street 1:1926 E 2ND ST
Practice Address - Street 2:APT. 8
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-3578
Practice Address - Country:US
Practice Address - Phone:715-718-0013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14604-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)