Provider Demographics
NPI:1932510658
Name:RICHARDS, JESSICA ELLEN (MS CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:ELLEN
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 1:126 ATLANTA ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-5508
Mailing Address - Country:US
Mailing Address - Phone:270-519-0257
Mailing Address - Fax:
Practice Address - Street 1:126 ATLANTA ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-5508
Practice Address - Country:US
Practice Address - Phone:270-519-0257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4405235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist