Provider Demographics
NPI:1801582499
Name:RICHARDSON, CYNTHIA LOIS TILLERY (MSCCCSLP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LOIS TILLERY
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 STONEBROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:NOLENSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37135-9710
Mailing Address - Country:US
Mailing Address - Phone:615-419-8054
Mailing Address - Fax:
Practice Address - Street 1:4200 MURFREESBORO PIKE
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-2789
Practice Address - Country:US
Practice Address - Phone:615-501-3529
Practice Address - Fax:615-501-3702
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1322235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist