Provider Demographics
NPI:1922401785
Name:HIDALGO, JESSE C JR
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:C
Last Name:HIDALGO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N BALTIMORE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-1616
Mailing Address - Country:US
Mailing Address - Phone:316-737-9344
Mailing Address - Fax:
Practice Address - Street 1:10318 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209
Practice Address - Country:US
Practice Address - Phone:316-558-2100
Practice Address - Fax:316-558-5229
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK986237700000X
NE741237700000X
KS1117237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist