Provider Demographics
NPI:1770104036
Name:RICHARDS, MEREDITH (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4209 PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3230
Mailing Address - Country:US
Mailing Address - Phone:612-790-7970
Mailing Address - Fax:
Practice Address - Street 1:4209 PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-3230
Practice Address - Country:US
Practice Address - Phone:612-790-7970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist