Provider Demographics
NPI:1083922108
Name:KNUDTSON, ALISSA ANN (LISW)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:ANN
Last Name:KNUDTSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 82ND PL
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50322-4329
Mailing Address - Country:US
Mailing Address - Phone:515-412-5112
Mailing Address - Fax:515-412-5123
Practice Address - Street 1:2500 82ND PL
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-4329
Practice Address - Country:US
Practice Address - Phone:515-412-5112
Practice Address - Fax:515-412-5123
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0070641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical