Provider Demographics
NPI:1871660563
Name:KNAPP, CARLY JEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:CARLY
Middle Name:JEAN
Last Name:KNAPP
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33515 10TH PL S
Mailing Address - Street 2:BLDG. #16
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7300
Mailing Address - Country:US
Mailing Address - Phone:253-838-5420
Mailing Address - Fax:253-838-5421
Practice Address - Street 1:33515 10TH PL S
Practice Address - Street 2:BLDG. #16
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7300
Practice Address - Country:US
Practice Address - Phone:253-838-5420
Practice Address - Fax:253-838-5421
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003487103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist