Individual
DR. KELLY JO KNUTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
808 S ELDORADO RD, STE 102, BLOOMINGTON, IL 61704-6071
(309) 706-3190
(309) 588-4115
Mailing address
1770 SOUTH RANDALL ROAD, STE: A # 179, GENEVA, IL 60134-0603
(309) 313-3789
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.007927
IL
Other
Enumeration date
07/27/2010
Last updated
11/19/2021
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