Provider Demographics
NPI:1104042167
Name:KNOWLES, LEAH MICHELLE (MT)
Entity type:Individual
Prefix:MISS
First Name:LEAH
Middle Name:MICHELLE
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:MT
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 282
Mailing Address - Street 2:
Mailing Address - City:TWISP
Mailing Address - State:WA
Mailing Address - Zip Code:98856-0282
Mailing Address - Country:US
Mailing Address - Phone:509-449-6368
Mailing Address - Fax:
Practice Address - Street 1:214 GLOVER ST N
Practice Address - Street 2:
Practice Address - City:TWISP
Practice Address - State:WA
Practice Address - Zip Code:98856
Practice Address - Country:US
Practice Address - Phone:509-449-6368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015169171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0162426OtherLABOR AND IND PIN
WA0162426OtherLABOR AND IND PIN