Provider Demographics
NPI:1407894900
Name:KLUCK, RICHELLE ADAIR (MS, CCC/A)
Entity Type:Individual
Prefix:MRS
First Name:RICHELLE
Middle Name:ADAIR
Last Name:KLUCK
Suffix:
Gender:F
Credentials:MS, CCC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 EASTVIEW CT
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233-1873
Mailing Address - Country:US
Mailing Address - Phone:573-814-6651
Mailing Address - Fax:573-814-6328
Practice Address - Street 1:800 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5275
Practice Address - Country:US
Practice Address - Phone:573-814-6651
Practice Address - Fax:573-814-6328
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002010418231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist