Provider Demographics
NPI:1811052905
Name:KNOWLES, PHILIP L (PHD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:L
Last Name:KNOWLES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5194
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98046-5194
Mailing Address - Country:US
Mailing Address - Phone:425-774-1538
Mailing Address - Fax:425-744-1527
Practice Address - Street 1:21616 76TH AVE W
Practice Address - Street 2:#102
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7512
Practice Address - Country:US
Practice Address - Phone:425-774-1538
Practice Address - Fax:425-744-1527
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00000874103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R79184Medicare UPIN