Individual
DR. SUSAN MARIE RADTKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071006342
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-0637807
FEDERAL TAX ID
IL
01
—
01632203
BLUE CROSS/BLUE SHIELD ID
IL
Enumeration date
07/19/2006
Last updated
11/20/2025
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