Provider Demographics
NPI:1285496414
Name:KNUUTILA, ANNETTE
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:KNUUTILA
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 1:420 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3830
Mailing Address - Country:US
Mailing Address - Phone:419-545-0840
Mailing Address - Fax:
Practice Address - Street 1:420 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3830
Practice Address - Country:US
Practice Address - Phone:419-545-0840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician