Provider Demographics
NPI:1740953041
Name:RICHARDSON, GENEVIEVE CELESTE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:CELESTE
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 1:1600 KEMP HILLS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-8859
Mailing Address - Country:US
Mailing Address - Phone:805-551-9958
Mailing Address - Fax:
Practice Address - Street 1:1600 KEMP HILLS DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-8859
Practice Address - Country:US
Practice Address - Phone:805-551-9958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112451235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty