Provider Demographics
NPI:1477566651
Name:HILDRETH, RHONDA NEWBERRY (LSCSW)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:NEWBERRY
Last Name:HILDRETH
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 N BALTIMORE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-1641
Mailing Address - Country:US
Mailing Address - Phone:316-788-2200
Mailing Address - Fax:
Practice Address - Street 1:425 N BALTIMORE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-1641
Practice Address - Country:US
Practice Address - Phone:316-788-2200
Practice Address - Fax:316-788-1514
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS19441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS070560Medicare ID - Type Unspecified