Provider Demographics
NPI:1104132232
Name:RICHARDSON, ALICIA MARIE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
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 1:1330 OAKRIDGE DR UNIT 10
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5706
Mailing Address - Country:US
Mailing Address - Phone:970-419-0486
Mailing Address - Fax:
Practice Address - Street 1:1330 OAKRIDGE DR UNIT 10
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-9652
Practice Address - Country:US
Practice Address - Phone:970-419-0486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO73055235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist