Provider Demographics
NPI:1801915079
Name:TUCKER-RICHARDSON, CARMEN R (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:R
Last Name:TUCKER-RICHARDSON
Suffix:
Gender:F
Credentials:MA, 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:PO BOX 43893
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-0893
Mailing Address - Country:US
Mailing Address - Phone:443-579-4757
Mailing Address - Fax:
Practice Address - Street 1:1 OLYMPIC PL
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4104
Practice Address - Country:US
Practice Address - Phone:443-579-4757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05266235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist