Provider Demographics
NPI:1427392786
Name:RADKE, KRISTEN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:RADKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14300 N NORTHSIGHT BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3673
Mailing Address - Country:US
Mailing Address - Phone:623-680-3486
Mailing Address - Fax:
Practice Address - Street 1:14300 N NORTHSIGHT BLVD STE 103
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3673
Practice Address - Country:US
Practice Address - Phone:623-680-3486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ187401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical