Provider Demographics
NPI:1316951015
Name:KNIGHT FORBES, PETRA KATHLEEN (MSW)
Entity type:Individual
Prefix:
First Name:PETRA
Middle Name:KATHLEEN
Last Name:KNIGHT FORBES
Suffix:
Gender:F
Credentials:MSW
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 1177
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1177
Mailing Address - Country:US
Mailing Address - Phone:231-728-4444
Mailing Address - Fax:231-728-4451
Practice Address - Street 1:923 S BEECHTREE ST
Practice Address - Street 2:SUITE 10
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2306
Practice Address - Country:US
Practice Address - Phone:616-638-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801085949104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker