Provider Demographics
NPI:1508626953
Name:KIDANE, RODAS
Entity Type:Individual
Prefix:
First Name:RODAS
Middle Name:
Last Name:KIDANE
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 1:1350 ENERGY LN STE 109
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-5254
Mailing Address - Country:US
Mailing Address - Phone:651-269-2760
Mailing Address - Fax:651-340-6107
Practice Address - Street 1:1350 ENERGY LN STE 109
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-5254
Practice Address - Country:US
Practice Address - Phone:651-269-2760
Practice Address - Fax:651-340-6107
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician