Provider Demographics
NPI:1821242652
Name:RICHARDS, MONICA GAYNAIL ELIZABETH (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:GAYNAIL ELIZABETH
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635-4015
Mailing Address - Country:US
Mailing Address - Phone:870-364-8180
Mailing Address - Fax:
Practice Address - Street 1:1413 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-4015
Practice Address - Country:US
Practice Address - Phone:870-364-8180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP2383235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR168754721Medicaid