Provider Demographics
NPI:1861810616
Name:RADOSEVIC, JENNIFER (MA, CCC-SP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:RADOSEVIC
Suffix:
Gender:F
Credentials:MA, CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 MASSILLON RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-4258
Mailing Address - Country:US
Mailing Address - Phone:330-798-1008
Mailing Address - Fax:330-798-1168
Practice Address - Street 1:3258 NIDOVER DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-4628
Practice Address - Country:US
Practice Address - Phone:330-798-1008
Practice Address - Fax:330-798-1168
Is Sole Proprietor?:No
Enumeration Date:2014-03-30
Last Update Date:2014-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP3629235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist