Healthcare Provider Details

I. General information

NPI: 1962384008
Provider Name (Legal Business Name): THOMAS RICHARD RADFORD JR. LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7625 N UNIVERSITY ST STE B1
PEORIA IL
61614-8304
US

IV. Provider business mailing address

7625 N UNIVERSITY ST STE B1
PEORIA IL
61614-8304
US

V. Phone/Fax

Practice location:
  • Phone: 309-676-0538
  • Fax:
Mailing address:
  • Phone: 309-676-0538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number150.129047
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: