Provider Demographics
NPI:1467918573
Name:RICHARDSON, JOANNA KAREN (MS)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:KAREN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 LAGUNA HONDA BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1409
Mailing Address - Country:US
Mailing Address - Phone:415-702-6009
Mailing Address - Fax:415-920-9598
Practice Address - Street 1:258 LAGUNA HONDA BLVD STE B
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1409
Practice Address - Country:US
Practice Address - Phone:415-702-6009
Practice Address - Fax:415-920-9598
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13312390200000X
CA29662235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program