Provider Demographics
NPI:1568201481
Name:KNOWLES, JEFFERSON DEAN (BACHELORS DEGREE)
Entity type:Individual
Prefix:
First Name:JEFFERSON
Middle Name:DEAN
Last Name:KNOWLES
Suffix:
Gender:M
Credentials:BACHELORS DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5133
Mailing Address - Country:US
Mailing Address - Phone:208-613-0142
Mailing Address - Fax:
Practice Address - Street 1:212 JACKSON ST
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5133
Practice Address - Country:US
Practice Address - Phone:208-613-0142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician