Provider Demographics
NPI:1184027765
Name:RADEWAHN, EMILY GRACE (BA, BCABA)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:GRACE
Last Name:RADEWAHN
Suffix:
Gender:F
Credentials:BA, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12836 OLD GLENN HWY
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7041
Mailing Address - Country:US
Mailing Address - Phone:907-726-5330
Mailing Address - Fax:
Practice Address - Street 1:12836 OLD GLENN HWY
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7041
Practice Address - Country:US
Practice Address - Phone:907-726-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst