Provider Demographics
NPI:1770612368
Name:RICHARDS, RICHELLE MARIE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:RICHELLE
Middle Name:MARIE
Last Name:RICHARDS
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 1:20613 N 63RD DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6615
Mailing Address - Country:US
Mailing Address - Phone:602-882-8121
Mailing Address - Fax:623-842-2844
Practice Address - Street 1:20613 N 63RD DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6615
Practice Address - Country:US
Practice Address - Phone:602-882-8121
Practice Address - Fax:623-842-2844
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0181235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLP0181OtherSTATE SPEECH LICENSE