Provider Demographics
NPI:1215449046
Name:KNUTSON, TERRI JEAN
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:JEAN
Last Name:KNUTSON
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 1:7929 W CENTER RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3104
Mailing Address - Country:US
Mailing Address - Phone:877-518-1070
Mailing Address - Fax:402-591-5075
Practice Address - Street 1:3568 DODGE ST STE 2
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-3222
Practice Address - Country:US
Practice Address - Phone:402-345-0791
Practice Address - Fax:402-345-0938
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
NE172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No175T00000XOther Service ProvidersPeer Specialist