Provider Demographics
NPI:1164572871
Name:RICHARDSON, ELIZABETH CHRISTINE (SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CHRISTINE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 WYNNCREST CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-8768
Mailing Address - Country:US
Mailing Address - Phone:919-358-7089
Mailing Address - Fax:919-326-2612
Practice Address - Street 1:1321 WYNNCREST CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-8768
Practice Address - Country:US
Practice Address - Phone:919-358-7089
Practice Address - Fax:919-326-2612
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5219235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4600072OtherUNITED HEALTHCARE
NC7411702Medicaid
7368432OtherAETNA
B6407OtherMEDCOST
NC1279UOtherBCBS
NC8300041KOtherMEDICAID CBRS