Provider Demographics
NPI:1730226929
Name:HIDAKA, ROXANNE KIRK
Entity type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:KIRK
Last Name:HIDAKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 W 85TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-1650
Mailing Address - Country:US
Mailing Address - Phone:913-636-8098
Mailing Address - Fax:913-642-1806
Practice Address - Street 1:5710 W 85TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207-1650
Practice Address - Country:US
Practice Address - Phone:913-636-8098
Practice Address - Fax:913-642-1806
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator