Provider Demographics
NPI:1639324932
Name:RADVILLE, KATHARINE MARY
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:MARY
Last Name:RADVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SPOFFORD RD
Mailing Address - Street 2:#2
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-3403
Mailing Address - Country:US
Mailing Address - Phone:617-365-5501
Mailing Address - Fax:
Practice Address - Street 1:233 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-4840
Practice Address - Country:US
Practice Address - Phone:781-843-1860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CFY- IN PROGRESS MA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist