Provider Demographics
NPI:1578004727
Name:RADTKE-ADAMS, DAWN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:RADTKE-ADAMS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:RADTKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:11735 NW WINTER PARK TER UNIT 304
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-6288
Mailing Address - Country:US
Mailing Address - Phone:503-421-1274
Mailing Address - Fax:
Practice Address - Street 1:527 SE BASELINE ST STE G
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4149
Practice Address - Country:US
Practice Address - Phone:971-770-5009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13229235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist