MEDICARE: MS. DEIDRE MONIQUE RADFORD OCP,CDCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist		OH

General Provider Information

NPI Number	:	1700395357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEIDRE MONIQUE RADFORD OCP,CDCA

Provider Business Mailing Address
First Line	:	3770 N HIGH ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3525
Country	:	US
Telephone Number	:	614-294-7117
Fax Number	:

Provider Business Practice Location Address
First Line	:	3770 NORTH HIGH ST.
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214
Country	:	US
Telephone Number	:	614-294-7117
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2017
Last Update Date	:	07/21/2022

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