Provider Demographics
NPI:1568616472
Name:RICHARDSON-VERDILE, TRISHA ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:ANN
Last Name:RICHARDSON-VERDILE
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 1:3 CENTURY DR
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4205
Mailing Address - Country:US
Mailing Address - Phone:518-312-8289
Mailing Address - Fax:
Practice Address - Street 1:3 CENTURY DR
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-4205
Practice Address - Country:US
Practice Address - Phone:518-884-0226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012524-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist