Provider Demographics
NPI:1447599857
Name:RICHERT, KELLY OCONNOR
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:OCONNOR
Last Name:RICHERT
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 1:8030 SUNNY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2341
Mailing Address - Country:US
Mailing Address - Phone:901-734-0959
Mailing Address - Fax:
Practice Address - Street 1:8030 SUNNY CREEK DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2341
Practice Address - Country:US
Practice Address - Phone:901-734-0959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001318235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist