Provider Demographics
NPI:1700811338
Name:RADERMACHER, KATHARINE RHONDA (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATHARINE
Middle Name:RHONDA
Last Name:RADERMACHER
Suffix:
Gender:F
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 1:146 W BEATON DR
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-2657
Mailing Address - Country:US
Mailing Address - Phone:701-356-0062
Mailing Address - Fax:701-356-5412
Practice Address - Street 1:3001 11TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6048
Practice Address - Country:US
Practice Address - Phone:701-356-0062
Practice Address - Fax:701-356-5412
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7482235Z00000X
ND531235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1452524Medicaid
NDN717581Medicare PIN