Provider Demographics
NPI:1639855919
Name:RICHARDS, ALIYA GRACE JAE (CF-SLP)
Entity Type:Individual
Prefix:MISS
First Name:ALIYA
Middle Name:GRACE JAE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 STATE ROUTE 1686
Mailing Address - Street 2:
Mailing Address - City:FANCY FARM
Mailing Address - State:KY
Mailing Address - Zip Code:42039-9558
Mailing Address - Country:US
Mailing Address - Phone:270-293-1914
Mailing Address - Fax:
Practice Address - Street 1:1710 HIGHWAY 121 BYP N STE K
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-8762
Practice Address - Country:US
Practice Address - Phone:270-767-6853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY285758235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist