Provider Demographics
NPI:1013115575
Name:RICHARDSON, JANA HAMILTON (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:HAMILTON
Last Name:RICHARDSON
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 1:2552 LEWISBURG HWY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-6452
Mailing Address - Country:US
Mailing Address - Phone:931-433-8205
Mailing Address - Fax:
Practice Address - Street 1:1805 N JACKSON ST
Practice Address - Street 2:SUITE 2-3 JACKSON MEDICAL PLAZA
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2290
Practice Address - Country:US
Practice Address - Phone:931-393-7964
Practice Address - Fax:931-455-6308
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002970235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist