Provider Demographics
NPI:1912459082
Name:RADLEY, PATRICIA (MSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:RADLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-1503
Mailing Address - Country:US
Mailing Address - Phone:630-746-5456
Mailing Address - Fax:708-360-9132
Practice Address - Street 1:1312 TIMBERLINE DR
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-1503
Practice Address - Country:US
Practice Address - Phone:630-746-5456
Practice Address - Fax:708-360-9132
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490048781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical