Provider Demographics
NPI:1720018567
Name:PRESCOTT, RICHARD A (MA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:A
Last Name:PRESCOTT
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W COLUMBIA ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1782
Mailing Address - Country:US
Mailing Address - Phone:812-425-2646
Mailing Address - Fax:
Practice Address - Street 1:3801 BELLEMEADE AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0100
Practice Address - Country:US
Practice Address - Phone:812-425-2646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23001999237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN00000000OtherNONE