Provider Demographics
NPI:1538584305
Name:KNUTSON, WENDY
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:KNUTSON
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:PO BOX 1984
Mailing Address - Street 2:
Mailing Address - City:DIAMOND SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95619-1984
Mailing Address - Country:US
Mailing Address - Phone:530-295-1491
Mailing Address - Fax:530-621-1082
Practice Address - Street 1:4250 FOWLER LN
Practice Address - Street 2:#204
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619-9781
Practice Address - Country:US
Practice Address - Phone:530-295-1491
Practice Address - Fax:530-621-1082
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health