Provider Demographics
NPI:1336409804
Name:JENNI KNOWLES, PH.D., LP, LLC
Entity type:Organization
Organization Name:JENNI KNOWLES, PH.D., LP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:248-320-1196
Mailing Address - Street 1:6633 ELLINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48383-3083
Mailing Address - Country:US
Mailing Address - Phone:248-320-1196
Mailing Address - Fax:
Practice Address - Street 1:200 E BIG BEAVER RD # 116
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1208
Practice Address - Country:US
Practice Address - Phone:248-320-1196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014248103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP34490005Medicare PIN