Provider Demographics
NPI:1780917096
Name:RICHARDSON, BRENDA DORENE (MA,COMS)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:DORENE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MA,COMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8152 S CLYDE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-1115
Mailing Address - Country:US
Mailing Address - Phone:773-979-0007
Mailing Address - Fax:
Practice Address - Street 1:8152 S CLYDE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-1115
Practice Address - Country:US
Practice Address - Phone:773-979-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training Provider