Provider Demographics
NPI:1750974465
Name:FIDDES, MAGGIE (RBT)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:FIDDES
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9301 W 148TH TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221-9372
Mailing Address - Country:US
Mailing Address - Phone:913-660-2980
Mailing Address - Fax:
Practice Address - Street 1:7050 W 107TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1810
Practice Address - Country:US
Practice Address - Phone:913-802-2227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-20-115228106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician