Provider Demographics
NPI:1104945518
Name:KNOWLTON, DIEDRE A (MSW, ASW)
Entity type:Individual
Prefix:
First Name:DIEDRE
Middle Name:A
Last Name:KNOWLTON
Suffix:
Gender:F
Credentials:MSW, ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 30TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-7208
Mailing Address - Country:US
Mailing Address - Phone:760-420-7526
Mailing Address - Fax:
Practice Address - Street 1:4026 NE 55TH ST STE D
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-2254
Practice Address - Country:US
Practice Address - Phone:206-941-4474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61961041C0700X
CA270151041C0700X
1041C0700X
WA602317031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical