Provider Demographics
NPI:1346871654
Name:RADCHENKO, KEANDRA E
Entity type:Individual
Prefix:
First Name:KEANDRA
Middle Name:E
Last Name:RADCHENKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 N SCHOOLHOUSE HILL RD
Mailing Address - Street 2:
Mailing Address - City:HOODSPORT
Mailing Address - State:WA
Mailing Address - Zip Code:98548-4505
Mailing Address - Country:US
Mailing Address - Phone:360-463-3649
Mailing Address - Fax:
Practice Address - Street 1:4227 S MERIDIAN STE C422
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3603
Practice Address - Country:US
Practice Address - Phone:888-362-3970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst