Provider Demographics
NPI:1609172741
Name:RADZICKI, LOUISE D (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:D
Last Name:RADZICKI
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2473 FREEPORT ST
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-4526
Mailing Address - Country:US
Mailing Address - Phone:516-804-2607
Mailing Address - Fax:
Practice Address - Street 1:2473 FREEPORT ST
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-4526
Practice Address - Country:US
Practice Address - Phone:516-804-2607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58016274235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist