Provider Demographics
NPI:1578243978
Name:RADZISZEWSKI, MEGAN VIOLETTE (BA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:VIOLETTE
Last Name:RADZISZEWSKI
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 FOREST AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1884
Mailing Address - Country:US
Mailing Address - Phone:207-797-8255
Mailing Address - Fax:
Practice Address - Street 1:1250 FOREST AVE STE 301
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-1884
Practice Address - Country:US
Practice Address - Phone:207-797-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESAS39102355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant