Provider Demographics
NPI:1598049512
Name:RICHARDSON, JOHN FREDERICK II (MS,CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FREDERICK
Last Name:RICHARDSON
Suffix:II
Gender:M
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 1:2035 HAPPY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-5414
Mailing Address - Country:US
Mailing Address - Phone:865-453-0130
Mailing Address - Fax:
Practice Address - Street 1:5908 LYONS VIEW PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-7520
Practice Address - Country:US
Practice Address - Phone:865-588-0508
Practice Address - Fax:865-558-0226
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP1025235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist