Provider Demographics
NPI:1003217068
Name:RICHMOND, CHESA
Entity type:Individual
Prefix:
First Name:CHESA
Middle Name:
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CHESA
Other - Middle Name:
Other - Last Name:RICHMOND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP-CCC
Mailing Address - Street 1:11660 CHURCH ST APT 492
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-8945
Mailing Address - Country:US
Mailing Address - Phone:202-247-0653
Mailing Address - Fax:
Practice Address - Street 1:275 W HOSPITALITY LN STE 103
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3238
Practice Address - Country:US
Practice Address - Phone:909-567-2221
Practice Address - Fax:909-763-3216
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management