Healthcare Provider Details

I. General information

NPI: 1730095530
Provider Name (Legal Business Name): AUTUMN RADTKE MS, CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 BIRCH ST
OAKLAND CA
94621-2313
US

IV. Provider business mailing address

915 54TH ST
OAKLAND CA
94608-3142
US

V. Phone/Fax

Practice location:
  • Phone: 510-879-2107
  • Fax:
Mailing address:
  • Phone: 510-879-5003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: