Individual
SUZANNE RADOSEVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.S.W., R.B.T.
Contact information
Practice address
10313 ABOITE CENTER RD, FORT WAYNE, IN 46804-5435
(260) 459-6040
Mailing address
10313 ABOITE CENTER RD, FORT WAYNE, IN 46804-5435
(260) 459-6040
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
203800479
CHILDREN'S AUTISM CENTER
IN
Enumeration date
01/21/2016
Last updated
01/21/2016
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