Provider Demographics
NPI:1346057874
Name:RADOCAJ, AMILIA MARIE
Entity type:Individual
Prefix:
First Name:AMILIA
Middle Name:MARIE
Last Name:RADOCAJ
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 1:9859 S COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-5439
Mailing Address - Country:US
Mailing Address - Phone:773-946-8906
Mailing Address - Fax:
Practice Address - Street 1:8398 MISSISSIPPI ST
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6316
Practice Address - Country:US
Practice Address - Phone:219-755-4049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILBACB1233938106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician