Provider Demographics
NPI:1801443254
Name:KNOTT, LESLIE HANNAH FAITH (LCSW, CRAADC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:HANNAH FAITH
Last Name:KNOTT
Suffix:
Gender:F
Credentials:LCSW, CRAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 N SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-5219
Mailing Address - Country:US
Mailing Address - Phone:573-587-3937
Mailing Address - Fax:
Practice Address - Street 1:402 S SILVER SPRINGS RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-7536
Practice Address - Country:US
Practice Address - Phone:573-334-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210337741041C0700X
MO2019025018101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical