Provider Information for 1952641532
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DORLEA ANN KNIZLEY LPC
Sex: Female
NPI: 1952641532
Last Updated: 2013-02-19
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1952641532 | ||||||||
| Enumeration Date | 2013-02-19 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 34 CHURCH ST PRIEST RIVER, ID 83856-6544 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 34 CHURCH ST PRIEST RIVER, ID 83856-6544 United States Phone: 208-448-4855 | Fax:208-448-2467 | ||||||||
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