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General NPI Number Information
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NPI Number | 1326067331
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Entity Type | Individual
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Provider Name | SUSAN MARIE RADTKE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 8581 DOLFOR CV
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City | BURR RIDGE
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State | IL
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Zip | 60527-8350
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Country | US
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Telephone | 630-740-7983
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Fax | 630-323-5304
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Provider Business Mailing Address
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Address Line | 8581 DOLFOR CV
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City | BURR RIDGE
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State | IL
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Zip | 60527-8350
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Country | US
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Telephone | 630-740-7983
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Fax | 630-323-5304
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071006342
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License Number State | IL
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