Sue C Radtke, PH.D.
Individual provider Active NPI Psychologist · Jackson, WI
NPI 1972834604 · NPPES record last updated Jan 20, 2010
Key facts
- NPI
- 1972834604
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 2828-057 (WI)
- Practice address
- 4476 Bittersweet CT
Jackson, WI 53037-9754 - Phone
- (262) 573-9568
- NPI assigned
- Jan 20, 2010
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2828-057 | WI | MD | Psychologist |
| 071.007726 | IL | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2828-057 | WI | Yes |
| Clinical Psychologist | 103TC0700X | 071.007726 | IL |
Addresses
Primary practice location
4476 Bittersweet CT
Jackson, WI 53037-9754
Mailing address
4476 Bittersweet CT
Jackson, WI 53037-9754
Phone (262) 573-9568
Other providers in Jackson, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 20, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.