Provider Demographics
NPI:1104333640
Name:RADNOVICH, NATASHA ANN (MED)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:ANN
Last Name:RADNOVICH
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-2842
Mailing Address - Country:US
Mailing Address - Phone:630-621-0414
Mailing Address - Fax:630-961-3499
Practice Address - Street 1:533 S 5TH ST
Practice Address - Street 2:
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118
Practice Address - Country:US
Practice Address - Phone:630-621-0414
Practice Address - Fax:224-293-2229
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2018-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst