Provider Demographics
NPI:1336206176
Name:RADUE, MELISSA K (MA CCCA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:K
Last Name:RADUE
Suffix:
Gender:F
Credentials:MA CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 OXFORD DRIVE
Mailing Address - Street 2:SUITE LLC
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102
Mailing Address - Country:US
Mailing Address - Phone:412-831-7570
Mailing Address - Fax:412-831-7073
Practice Address - Street 1:1300 OXFORD DRIVE
Practice Address - Street 2:SUITE LLC
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102
Practice Address - Country:US
Practice Address - Phone:412-831-7570
Practice Address - Fax:412-831-7073
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT005938231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA091426G2DOtherGROUP MEMBER PTAN
PARA1737857OtherHIGHMARK BCBS
PA091426G2DOtherGROUP MEMBER PTAN
PARA1737857OtherHIGHMARK BCBS
PA091426RX4Medicare ID - Type Unspecified