Provider Demographics
NPI:1053917153
Name:KNOWLTON, ROSA HAYDEE (LMSW)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:HAYDEE
Last Name:KNOWLTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 PETERSON RD STE 104
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-1739
Mailing Address - Country:US
Mailing Address - Phone:785-371-1414
Mailing Address - Fax:
Practice Address - Street 1:3320 PETERSON RD STE 104
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-1739
Practice Address - Country:US
Practice Address - Phone:785-371-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-05
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS160541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS11098OtherSOCIAL WORK
11098OtherSOCIAL WORK