Individual
CHARLIE NICHOLE KNOWLTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
12360 E BURNSIDE ST, PORTLAND, OR 97233-1042
(971) 279-4800
(971) 279-2051
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(503) 224-1044
(503) 621-2235
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
3385
OR
103TC0700X
Clinical Psychologist
Primary
3385
OR
103TC1900X
Counseling Psychologist
3385
OR
Other
Enumeration date
06/06/2016
Last updated
09/27/2021
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