Provider Demographics
NPI:1265440911
Name:RICHARDS, CRISTIN ROSE (AUD)
Entity type:Individual
Prefix:MRS
First Name:CRISTIN
Middle Name:ROSE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:CRISTIN
Other - Middle Name:ROSE
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:331 MAINE ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3358
Mailing Address - Country:US
Mailing Address - Phone:207-729-4086
Mailing Address - Fax:207-449-1193
Practice Address - Street 1:331 MAINE ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3358
Practice Address - Country:US
Practice Address - Phone:207-729-4086
Practice Address - Fax:207-729-4853
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1273231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME034364Medicare ID - Type Unspecified