Provider Demographics
NPI:1538198759
Name:KNOWLTON, O'NEILL & ASSOCIATES, P.C.
Entity type:Organization
Organization Name:KNOWLTON, O'NEILL & ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEGSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:701-364-0060
Mailing Address - Street 1:1401 13TH AVE E
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-3468
Mailing Address - Country:US
Mailing Address - Phone:701-364-0060
Mailing Address - Fax:701-364-0065
Practice Address - Street 1:1401 13TH AVE E
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-3468
Practice Address - Country:US
Practice Address - Phone:701-364-0060
Practice Address - Fax:701-364-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN010742500Medicaid
MN266S2KNOtherBCBS-MN GROUP #
85532OtherHEALTHPARTNERS GROUP #
ND056356001OtherBCBS-ND CLINIC #
ND12045Medicaid