Organization
BAY CENTER THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEIRDRE RADOSEVICH PH.D. (OWNER)
(920) 430-0736
Entity
Organization
Contact information
Practice address
5317 W GRANDE MARKET DR STE F7, APPLETON, WI 54913-8465
(920) 430-0736
Mailing address
3336 COTTAGE HILL DR, GREEN BAY, WI 54311-6139
(740) 972-1075
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
06/26/2015
Last updated
09/18/2018
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