Individual
PAUL MCKNIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
306 W 8TH ST, METROPOLIS, IL 62960-1653
(618) 524-3653
Mailing address
2259 PELL RD, BROOKPORT, IL 62910-2306
(618) 638-3717
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104100000X
—
IL
05
—
PAUL2259
—
IL
Enumeration date
01/10/2019
Last updated
01/10/2019
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