Provider Demographics
NPI:1992574420
Name:RADECKI, NATHAN J
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:J
Last Name:RADECKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 NW 140TH PL
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6160
Mailing Address - Country:US
Mailing Address - Phone:509-939-6452
Mailing Address - Fax:
Practice Address - Street 1:306 NW 140TH PL
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-6160
Practice Address - Country:US
Practice Address - Phone:509-939-6452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician