Provider Demographics
NPI:1669688347
Name:RADDATZ, HEIDI LYNN (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:LYNN
Last Name:RADDATZ
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:HEIDI
Other - Middle Name:LYNN
Other - Last Name:DEGROOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:302 N METONGA AVE
Mailing Address - Street 2:
Mailing Address - City:CRANDON
Mailing Address - State:WI
Mailing Address - Zip Code:54520-1344
Mailing Address - Country:US
Mailing Address - Phone:715-889-1584
Mailing Address - Fax:
Practice Address - Street 1:900 BOYCE DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3835
Practice Address - Country:US
Practice Address - Phone:715-365-6654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2847-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist