Provider Demographics
NPI:1578991196
Name:RICHMAN, JAY BURKE (AU D)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:BURKE
Last Name:RICHMAN
Suffix:
Gender:M
Credentials:AU D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1084 N COLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8642
Mailing Address - Country:US
Mailing Address - Phone:208-377-0019
Mailing Address - Fax:208-377-0313
Practice Address - Street 1:1084 N COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8642
Practice Address - Country:US
Practice Address - Phone:208-377-0019
Practice Address - Fax:208-377-0313
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAUD2464231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist