Provider Demographics
NPI:1891124434
Name:RICHARD, THERESA ANNE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:ANNE
Last Name:RICHARD
Suffix:
Gender:F
Credentials:MA, 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:PO BOX 50801
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89016-0801
Mailing Address - Country:US
Mailing Address - Phone:702-751-2193
Mailing Address - Fax:
Practice Address - Street 1:319 TEAL RIDGE HILLS DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-7614
Practice Address - Country:US
Practice Address - Phone:702-751-2193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-1620235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist