Provider Demographics
NPI:1780450239
Name:RICHARDSON, LAUREN ISABELL
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ISABELL
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ISABELL
Other - Last Name:SHULL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1175 SAYLOR DR APT D
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-6130
Mailing Address - Country:US
Mailing Address - Phone:513-532-1876
Mailing Address - Fax:
Practice Address - Street 1:7203 CAMARGO GREENE CT
Practice Address - Street 2:
Practice Address - City:MADEIRA
Practice Address - State:OH
Practice Address - Zip Code:45243-2237
Practice Address - Country:US
Practice Address - Phone:513-272-2218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46004634A235Z00000X
3747P1801X, 3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider