Provider Demographics
NPI:1043047236
Name:WASHINGTON, ROXANNE DANEEN
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:DANEEN
Last Name:WASHINGTON
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 1:11702 BUCKEYE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-5705
Mailing Address - Country:US
Mailing Address - Phone:216-905-5169
Mailing Address - Fax:
Practice Address - Street 1:2450 FAIRMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-3100
Practice Address - Country:US
Practice Address - Phone:216-905-5169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator