Provider Demographics
NPI:1205319688
Name:KNETGE, TAIANN CATHERINE
Entity type:Individual
Prefix:
First Name:TAIANN
Middle Name:CATHERINE
Last Name:KNETGE
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 1:3151 CAHUENGA BLVD W # STW335
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-1768
Mailing Address - Country:US
Mailing Address - Phone:626-354-8682
Mailing Address - Fax:
Practice Address - Street 1:3151 CAHUENGA BLVD W # STW335
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1768
Practice Address - Country:US
Practice Address - Phone:626-354-8682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1043951041C0700X
CAASW850401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical