Provider Demographics
NPI:1457233231
Name:ROSE, JESSICA LYN KNECHT
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYN KNECHT
Last Name:ROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYN
Other - Last Name:KNECHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1090 S TWIN LAKES AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:ID
Mailing Address - Zip Code:83644-5137
Mailing Address - Country:US
Mailing Address - Phone:208-724-3224
Mailing Address - Fax:
Practice Address - Street 1:620 9TH ST
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:ID
Practice Address - Zip Code:83644-6044
Practice Address - Country:US
Practice Address - Phone:208-585-2310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator