Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | 079626-1 | NY |
Y | 1041C0700X | Clinical Social Worker | LW 60315172 | WA |
NPI | 1003061227 |
---|---|
Provider Name | Ms. Alexandra M Knezo |
First Address | Bellingham, WA 98226-3557 |
Second Address | Bellingham, WA 98226-3557 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2008 |
Last Update Date | 20/02/2013 |