Provider Demographics
NPI:1780034355
Name:RICHMOND, CAITLYN (MSP CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:MSP CCC-SLP
Other - Prefix:
Other - First Name:CAITLYN
Other - Middle Name:
Other - Last Name:MCSALLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSP CCC-SLP
Mailing Address - Street 1:2 TALL PINES DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1470
Mailing Address - Country:US
Mailing Address - Phone:203-606-8774
Mailing Address - Fax:
Practice Address - Street 1:2 TALL PINES DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06478-1470
Practice Address - Country:US
Practice Address - Phone:203-606-8774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5709235Z00000X
CT5275235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist