Jan Radke, M.A., M.F.T,

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MFT20457 Issued in CA

Practice address

1023 College Ave
Santa Rosa, CA 95404-4112

Phone

(707) 486-0306

NPI assigned

Jul 25, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1311552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311552000000",
    "number": "1114205192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1654 HOPPER AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954038600",
            "telephone_number": "707-526-6947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1023 COLLEGE AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954044112",
            "telephone_number": "707-486-0306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADKE",
        "first_name": "JAN",
        "credential": "M.A., M.F.T,",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-07-25",
        "last_updated": "2011-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFT20457",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MARRIAGE AND FAMILY COUNSELING LICENSE",
            "identifier": "MFT20457",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.