Deirdre Radosevich, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2992-57 Issued in WI

Practice address

5317 W Grande Market Dr Ste F7
Appleton, WI 54913-8465

Phone

(920) 430-0736

NPI assigned

Apr 30, 2009

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)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bay Center Therapy

  • Clinical Psychologist
  • Appleton, WI
  • NPI 1346622214
  NPD (past) Authorized official
• Family Services of Northeast Wisconsin Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Menasha, WI
  • NPI 1275525925

  Single Specialty

  NPD (past)
• Family Services of Northeast Wisconsin Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Green Bay, WI
  • NPI 1467453167
  NPD (past)

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

{
    "created_epoch": "1241049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537228800000",
    "number": "1851535009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3336 COTTAGE HILL DR",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543116139",
            "telephone_number": "740-972-1075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5317 W GRANDE MARKET DR STE F7",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138465",
            "telephone_number": "920-430-0736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADOSEVICH",
        "first_name": "DEIRDRE",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-04-30",
        "last_updated": "2018-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "2992-57",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1346622214",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Radiation Oncology Specialists, SC
• Roxanne D Radich, APNP
• Radiology Associates of Appleton, S.C.
• Radiology Associates of Appleton, S.C.
• Toni Radish
• Brynn Radtke
• Scott W. Radtke, LPC
• Ubah Rage
• Bradley Rahikainen, DC
• Karim Mohammad Rahimi, MD

• Clinical Psychologist in Appleton, WI
• Providers in Appleton, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2018; 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.