Individual
MS. KATHY JEANNE RADOVICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
1948 S 75TH ST, WEST ALLIS, WI 53219-1255
(414) 321-8860
Mailing address
1948 S 75TH ST, WEST ALLIS, WI 53219-1255
(414) 321-8860
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
1210-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40555700
—
WI
Enumeration date
05/07/2008
Last updated
05/07/2008
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