Provider Demographics
NPI:1386460855
Name:RADOVICH, KARIANNE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KARIANNE
Middle Name:
Last Name:RADOVICH
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 1:17382 W 158TH TER
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-6760
Mailing Address - Country:US
Mailing Address - Phone:314-269-6658
Mailing Address - Fax:
Practice Address - Street 1:7415 GRANDVIEW ST
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-1796
Practice Address - Country:US
Practice Address - Phone:913-676-2253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist