Provider Demographics
NPI:1528754835
Name:KNECHTGES, DESIREE ROSE (RD)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:ROSE
Last Name:KNECHTGES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 WINDJAMMER LN
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-6241
Mailing Address - Country:US
Mailing Address - Phone:630-788-7403
Mailing Address - Fax:
Practice Address - Street 1:1270 WINDJAMMER LN
Practice Address - Street 2:
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-6241
Practice Address - Country:US
Practice Address - Phone:224-236-2352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered