Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003246653 |
---|---|
Provider Name | Della M Radke |
First Address | Salem, OR 97317-9350 |
Second Address | Salem, OR 97317-9350 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2013 |
Last Update Date | 20/02/2015 |