Provider Demographics
NPI:1043431984
Name:RADZIEWICZ, CHRISTINE K (DACCCSLP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:K
Last Name:RADZIEWICZ
Suffix:
Gender:F
Credentials:DACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 KILBURN RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1327
Mailing Address - Country:US
Mailing Address - Phone:516-248-7045
Mailing Address - Fax:
Practice Address - Street 1:125 MINEOLA AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:ROSLYN HTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2023
Practice Address - Country:US
Practice Address - Phone:516-625-8551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2108235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2108OtherLICENSE