Provider Demographics
NPI:1255008124
Name:NADRATOWSKI, LINZY MAE
Entity Type:Individual
Prefix:
First Name:LINZY
Middle Name:MAE
Last Name:NADRATOWSKI
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 1:830 S 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:IN
Mailing Address - Zip Code:46304-2718
Mailing Address - Country:US
Mailing Address - Phone:219-331-9474
Mailing Address - Fax:
Practice Address - Street 1:2005 VALPARAISO ST
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-3329
Practice Address - Country:US
Practice Address - Phone:219-252-5464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health