Provider Demographics
NPI:1841761665
Name:RICHARDSON, VANESSA LEE (BS)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:LEE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:LEE
Other - Last Name:SLOTHOUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHCA
Mailing Address - Street 1:8117 N DIVISION ST STE C
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-5765
Mailing Address - Country:US
Mailing Address - Phone:509-217-7880
Mailing Address - Fax:
Practice Address - Street 1:8117 N DIVISION ST STE C
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-5765
Practice Address - Country:US
Practice Address - Phone:509-217-7880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106E00000X
WACG60922320101YM0800X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1841761665Medicaid