Provider Demographics
NPI:1558559591
Name:RADEKE DANNACHER, JOAN HELENE (MA, CCC-SLP, RD/LDN)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:HELENE
Last Name:RADEKE DANNACHER
Suffix:
Gender:F
Credentials:MA, CCC-SLP, RD/LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 ANN ST
Mailing Address - Street 2:
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514-1452
Mailing Address - Country:US
Mailing Address - Phone:630-926-8307
Mailing Address - Fax:630-789-2870
Practice Address - Street 1:106 ANN ST
Practice Address - Street 2:
Practice Address - City:CLARENDON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60514-1452
Practice Address - Country:US
Practice Address - Phone:630-926-8307
Practice Address - Fax:630-789-2870
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146003788235Z00000X
IL164004948133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist