Healthcare Provider Details

I. General information

NPI: 1295642460
Provider Name (Legal Business Name): ASHLEE LAUREN RADZIKOWSKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 S FRANCES ST
SOUTH BEND IN
46617-3004
US

IV. Provider business mailing address

61969 OAK GROVE RD
CASSOPOLIS MI
49031-9621
US

V. Phone/Fax

Practice location:
  • Phone: 574-221-0446
  • Fax:
Mailing address:
  • Phone: 574-354-2449
  • Fax: 574-354-2449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34012769A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: