Provider Demographics
NPI:1700015336
Name:RADFORD, NOLA (PHD, CCC-SLP)
Entity Type:Individual
Prefix:PROF
First Name:NOLA
Middle Name:
Last Name:RADFORD
Suffix:
Gender:F
Credentials:PHD, 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:PO BOX 32692
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-2692
Mailing Address - Country:US
Mailing Address - Phone:865-985-1656
Mailing Address - Fax:
Practice Address - Street 1:HEARING AND SPEECH CTR
Practice Address - Street 2:1600 PEYTON MANNING PASS
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37996-0001
Practice Address - Country:US
Practice Address - Phone:865-974-2672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6005235Z00000X
MS49540235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist