Provider Demographics
NPI:1760169957
Name:RICHMOND, KATIE (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4191 W SARDINIA WAY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-7157
Mailing Address - Country:US
Mailing Address - Phone:573-579-7379
Mailing Address - Fax:
Practice Address - Street 1:3162 W MARTIN LUTHER KING JR BLVD STE 4
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-7679
Practice Address - Country:US
Practice Address - Phone:479-435-6636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR202269235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist