Provider Demographics
NPI:1235329772
Name:MCKNIGHT, JOHN BURTMENT III (CADCII)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:BURTMENT
Last Name:MCKNIGHT
Suffix:III
Gender:M
Credentials:CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52482 SE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-3615
Mailing Address - Country:US
Mailing Address - Phone:503-543-2551
Mailing Address - Fax:503-543-2382
Practice Address - Street 1:52482 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056-3615
Practice Address - Country:US
Practice Address - Phone:503-543-2551
Practice Address - Fax:503-543-2382
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR99-11-70101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)