Provider Demographics
NPI:1962362848
Name:KNAACK, STEPHANIE ELLEN
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ELLEN
Last Name:KNAACK
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 1:3511 OVERHULSE RD NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-3861
Mailing Address - Country:US
Mailing Address - Phone:253-370-9233
Mailing Address - Fax:
Practice Address - Street 1:3231 WILLAMETTE DR NE STE A
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-1378
Practice Address - Country:US
Practice Address - Phone:360-878-6434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-13
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA70063872106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician