Provider Demographics
NPI:1659501294
Name:RICHARDS, JILL M (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:M
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MISS
Other - First Name:JILL
Other - Middle Name:M
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:46 METACOMMETT DR
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-5428
Mailing Address - Country:US
Mailing Address - Phone:508-226-6518
Mailing Address - Fax:
Practice Address - Street 1:25 FOREST ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2407
Practice Address - Country:US
Practice Address - Phone:508-226-5743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4839235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist