Provider Demographics
NPI:1508830027
Name:RADEKE, JOANN T. (JOANN T RADEKE)
Entity Type:Individual
Prefix:
First Name:JOANN T.
Middle Name:
Last Name:RADEKE
Suffix:
Gender:F
Credentials:JOANN T RADEKE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142-0517
Mailing Address - Country:US
Mailing Address - Phone:972-932-3941
Mailing Address - Fax:
Practice Address - Street 1:1004 S WASHINGTON ST
Practice Address - Street 2:SUITE 110
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-2739
Practice Address - Country:US
Practice Address - Phone:972-932-3941
Practice Address - Fax:972-932-4941
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30886103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical