Provider Demographics
NPI:1659810752
Name:RICHARDSON, MELISSA (MS,CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MS,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 TRACE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3948
Mailing Address - Country:US
Mailing Address - Phone:205-789-4772
Mailing Address - Fax:
Practice Address - Street 1:330 TRACE RIDGE RD
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-3948
Practice Address - Country:US
Practice Address - Phone:205-789-4772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003960231H00000X
AL0620A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist