Provider Demographics
NPI:1376750570
Name:RADKE, MEGHANN D (MT-BC)
Entity Type:Individual
Prefix:
First Name:MEGHANN
Middle Name:D
Last Name:RADKE
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 105TH LN NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-4157
Mailing Address - Country:US
Mailing Address - Phone:763-258-4198
Mailing Address - Fax:
Practice Address - Street 1:1128 LASALLE AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2027
Practice Address - Country:US
Practice Address - Phone:612-321-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist