Provider Demographics
NPI:1407902703
Name:MCGOEY-RADSHAW, VIRGINIA (MED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:MCGOEY-RADSHAW
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 WHITNEY AVE
Mailing Address - Street 2:APT 8
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-1364
Mailing Address - Country:US
Mailing Address - Phone:203-988-4191
Mailing Address - Fax:
Practice Address - Street 1:357 WHITNEY AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2364
Practice Address - Country:US
Practice Address - Phone:203-773-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003511235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist