Provider Demographics
NPI:1235411364
Name:OLIVER-KNEEBONE, CHRISTINE MARI (LICSW)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:MARI
Last Name:OLIVER-KNEEBONE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1795 HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:TWO HARBORS
Mailing Address - State:MN
Mailing Address - Zip Code:55616-3018
Mailing Address - Country:US
Mailing Address - Phone:218-355-8645
Mailing Address - Fax:218-834-6005
Practice Address - Street 1:115 7TH ST
Practice Address - Street 2:
Practice Address - City:TWO HARBORS
Practice Address - State:MN
Practice Address - Zip Code:55616-1528
Practice Address - Country:US
Practice Address - Phone:218-834-6005
Practice Address - Fax:218-834-6005
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN192971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical