Provider Demographics
NPI:1093244014
Name:RETICKER, KADE M (MS CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:KADE
Middle Name:M
Last Name:RETICKER
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 RANDOLPH DR
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-1965
Mailing Address - Country:US
Mailing Address - Phone:214-215-5825
Mailing Address - Fax:
Practice Address - Street 1:146 MAPLE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-2504
Practice Address - Country:US
Practice Address - Phone:781-861-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist