Provider Demographics
NPI:1003217068
Name:RICHMOND, CHESA
Entity Type:Individual
Prefix:
First Name:CHESA
Middle Name:
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CHESA
Other - Middle Name:
Other - Last Name:RICHMOND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4402 28TH PL APT 2
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1539
Mailing Address - Country:US
Mailing Address - Phone:202-247-0653
Mailing Address - Fax:
Practice Address - Street 1:4402 28TH PL APT 2
Practice Address - Street 2:
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-1539
Practice Address - Country:US
Practice Address - Phone:202-247-0653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2019-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist