Provider Demographics
NPI:1033405659
Name:RADCLIFFE, LINDA H (MSP, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:H
Last Name:RADCLIFFE
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DEVANT ST
Mailing Address - Street 2:SUITE 703
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2710
Mailing Address - Country:US
Mailing Address - Phone:770-776-6013
Mailing Address - Fax:877-469-5558
Practice Address - Street 1:101 DEVANT ST
Practice Address - Street 2:SUITE 703
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2710
Practice Address - Country:US
Practice Address - Phone:770-776-6013
Practice Address - Fax:877-469-5558
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP003812235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G155590OtherMEDICARE
GA003125104BMedicaid