Provider Demographics
NPI:1255195723
Name:FLANNERY, RADHIKA
Entity type:Individual
Prefix:
First Name:RADHIKA
Middle Name:
Last Name:FLANNERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:WI
Mailing Address - Zip Code:53502-9401
Mailing Address - Country:US
Mailing Address - Phone:608-558-4223
Mailing Address - Fax:
Practice Address - Street 1:11 13TH AVE
Practice Address - Street 2:
Practice Address - City:NEW GLARUS
Practice Address - State:WI
Practice Address - Zip Code:53574-8919
Practice Address - Country:US
Practice Address - Phone:608-527-4844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI103K00000X103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst