Individual
DEIRDRE RADOSEVICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
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
2992-57
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346622214
—
WI
Enumeration date
04/30/2009
Last updated
09/18/2018
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