Provider Demographics
NPI:1730510736
Name:KNUDSON, THERESA
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:KNUDSON
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 1:2315 LIBRARY CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6327
Mailing Address - Country:US
Mailing Address - Phone:701-795-8550
Mailing Address - Fax:701-746-5523
Practice Address - Street 1:2315 LIBRARY CIR
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201
Practice Address - Country:US
Practice Address - Phone:701-795-8550
Practice Address - Fax:701-746-5523
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional