Provider Demographics
NPI:1598913659
Name:RADLOFF, YVONNE L MAHON (MS NYSL)
Entity Type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:L MAHON
Last Name:RADLOFF
Suffix:
Gender:F
Credentials:MS NYSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 INGALLS RD
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:NY
Mailing Address - Zip Code:14727-9102
Mailing Address - Country:US
Mailing Address - Phone:716-968-1456
Mailing Address - Fax:
Practice Address - Street 1:6100 INGALLS RD
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NY
Practice Address - Zip Code:14727-9102
Practice Address - Country:US
Practice Address - Phone:716-968-1456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014445-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist