Provider Demographics
NPI:1154625259
Name:RADOVICH, NATALIE
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:RADOVICH
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 1:3689 SPRING SHOWER DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-3787
Mailing Address - Country:US
Mailing Address - Phone:419-357-2174
Mailing Address - Fax:
Practice Address - Street 1:720 W CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7807
Practice Address - Country:US
Practice Address - Phone:419-458-6127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRS044008103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst