Provider Demographics
NPI:1467756460
Name:RICHARDSON, SUZANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 N ROCKY POINT DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5917
Mailing Address - Country:US
Mailing Address - Phone:219-781-2322
Mailing Address - Fax:
Practice Address - Street 1:2701 N ROCKY POINT DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5917
Practice Address - Country:US
Practice Address - Phone:813-288-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007364235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist