Healthcare Provider Details

I. General information

NPI: 1528763562
Provider Name (Legal Business Name): MARY KATHRYN RADCLIFF CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATIE RADCLIFF

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 W INA RD STE 100
TUCSON AZ
85741-2270
US

IV. Provider business mailing address

3580 W INA RD STE 100
TUCSON AZ
85741-2270
US

V. Phone/Fax

Practice location:
  • Phone: 520-355-5876
  • Fax:
Mailing address:
  • Phone: 520-355-5876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP14556
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: