Doctor Name: | MONICA G RADLEY |
NPI Number: | 1144530726 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 1345 Birch Ave. Cottage Grove, OR - 97424 |
Business Phone Number: | 5419423939 |
Business Fax Number: | 5419429310 |
Mailing Address: | 1117 E. Chamberlian Ave, COTTAGE GROVE |
State: | OR |
Postal Code: | 97424 |
Phone Number: | 5415254034 |
Fax Number: | |
NPI Enumeration Date: | 10/15/2010 |
NPI Last Update Date: | 10/15/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |