Provider Demographics
NPI:1811784143
Name:KNOWLES, KARA
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:KNOWLES
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 1:4570 N 176TH AVE
Mailing Address - Street 2:
Mailing Address - City:WALKERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49459-9700
Mailing Address - Country:US
Mailing Address - Phone:231-721-1921
Mailing Address - Fax:
Practice Address - Street 1:4232 CASCADE RD SE
Practice Address - Street 2:#3
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-9700
Practice Address - Country:US
Practice Address - Phone:877-654-4144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician