Provider Demographics
NPI:1700395357
Name:RADFORD, DEIDRE MONIQUE (OCP,CDCA)
Entity Type:Individual
Prefix:MS
First Name:DEIDRE
Middle Name:MONIQUE
Last Name:RADFORD
Suffix:
Gender:F
Credentials:OCP,CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3770 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3525
Mailing Address - Country:US
Mailing Address - Phone:614-294-7117
Mailing Address - Fax:
Practice Address - Street 1:3770 NORTH HIGH ST.
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214
Practice Address - Country:US
Practice Address - Phone:614-294-7117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist