Provider Demographics
NPI:1073092144
Name:RADER, JOEL
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:RADER
Suffix:
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 1:593 MICHAEL CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-5723
Mailing Address - Country:US
Mailing Address - Phone:470-503-6248
Mailing Address - Fax:
Practice Address - Street 1:1061 EUHARLEE RD
Practice Address - Street 2:
Practice Address - City:EUHARLEE
Practice Address - State:GA
Practice Address - Zip Code:30145-2807
Practice Address - Country:US
Practice Address - Phone:770-606-5871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET002731235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist