Provider Demographics
NPI:1922520212
Name:RADECKER, JENNIFER (RRT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:RADECKER
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:GOLOFORO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT
Mailing Address - Street 1:704 BLANCHE STREET
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003
Mailing Address - Country:US
Mailing Address - Phone:504-616-4655
Mailing Address - Fax:
Practice Address - Street 1:704 BLANCHE ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-7006
Practice Address - Country:US
Practice Address - Phone:504-616-4655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-09
Last Update Date:2017-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered