Provider Demographics
NPI:1174923973
Name:RICHTER, DENISE (CCC--SLP)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:RICHTER
Suffix:
Gender:F
Credentials:CCC--SLP
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:MARIE
Other - Last Name:BURELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:139 VILLAGE PATH
Mailing Address - Street 2:
Mailing Address - City:CASTROVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78009-5062
Mailing Address - Country:US
Mailing Address - Phone:830-931-4382
Mailing Address - Fax:
Practice Address - Street 1:139 VILLAGE PATH
Practice Address - Street 2:
Practice Address - City:CASTROVILLE
Practice Address - State:TX
Practice Address - Zip Code:78009-5062
Practice Address - Country:US
Practice Address - Phone:830-931-4382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007328235Z00000X
TX108483235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist