Provider Demographics
NPI:1962673806
Name:RICHBOURG, JANICE LEIGH (AUD, CCC/A)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:LEIGH
Last Name:RICHBOURG
Suffix:
Gender:F
Credentials:AUD, CCC/A
Other - Prefix:DR
Other - First Name:JANICE
Other - Middle Name:LEIGH
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD, CCC/A
Mailing Address - Street 1:1136 E GRANDE BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-3982
Mailing Address - Country:US
Mailing Address - Phone:903-592-3666
Mailing Address - Fax:903-595-3304
Practice Address - Street 1:1136 E GRANDE BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-3982
Practice Address - Country:US
Practice Address - Phone:903-592-3666
Practice Address - Fax:903-595-3304
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51568237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter