Individual
COURTNEY NICOLE RADDATZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
1919 N PEARL ST STE A4, TACOMA, WA 98406-2456
(253) 230-2919
(253) 761-8746
Mailing address
943 9TH ST SE APT 2, PUYALLUP, WA 98372-5710
(253) 230-2919
(253) 761-8746
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
00018940
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0194714
L&I PROVIDER #
WA
Enumeration date
12/07/2006
Last updated
07/29/2008
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