Provider Demographics
NPI:1679086334
Name:RAEDEKE, RHONDA CHRISTEL
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:CHRISTEL
Last Name:RAEDEKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 VALLEY FORGE TRL
Mailing Address - Street 2:
Mailing Address - City:ROCKTON
Mailing Address - State:IL
Mailing Address - Zip Code:61072-3034
Mailing Address - Country:US
Mailing Address - Phone:815-624-7992
Mailing Address - Fax:
Practice Address - Street 1:719 VALLEY FORGE TRL
Practice Address - Street 2:
Practice Address - City:ROCKTON
Practice Address - State:IL
Practice Address - Zip Code:61072-3034
Practice Address - Country:US
Practice Address - Phone:815-624-7992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-15
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1460003885235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist