Healthcare Provider Details

I. General information

NPI: 1700811338
Provider Name (Legal Business Name): KATHARINE RHONDA RADERMACHER MS,CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W BEATON DR
WEST FARGO ND
58078-2657
US

IV. Provider business mailing address

146 W BEATON DR
WEST FARGO ND
58078-2657
US

V. Phone/Fax

Practice location:
  • Phone: 701-261-4708
  • Fax:
Mailing address:
  • Phone: 701-261-4708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number19053
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7482
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number531
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: