Individual
KEITH KNUTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1220 DEWEY AVE, WAUWATOSA, WI 53213-2504
(414) 773-4312
(414) 454-6789
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
10407
WI
101YP2500X
Professional Counselor
10407125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100096897
—
WI
Enumeration date
03/20/2017
Last updated
03/26/2025
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