Provider Demographics
NPI:1669771598
Name:KNUTSON, DANA M
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:M
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 SONETT ST
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-4148
Mailing Address - Country:US
Mailing Address - Phone:619-442-5706
Mailing Address - Fax:
Practice Address - Street 1:1060 UNIVERSITY AVE STE A215
Practice Address - Street 2:MIRACLE-EAR CENTER
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-7345
Practice Address - Country:US
Practice Address - Phone:619-574-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA3612237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist