Provider Demographics
NPI:1376008045
Name:WALDRON, ROXANNE
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:
Last Name:WALDRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROXANNE
Other - Middle Name:
Other - Last Name:SHANKSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:126 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:MORENCI
Mailing Address - State:MI
Mailing Address - Zip Code:49256-1130
Mailing Address - Country:US
Mailing Address - Phone:517-306-3516
Mailing Address - Fax:
Practice Address - Street 1:1200 N WEST AVE STE 300
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2180
Practice Address - Country:US
Practice Address - Phone:517-789-1234
Practice Address - Fax:517-740-7040
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical