Provider Demographics
NPI:1881117745
Name:RICHARD, ANDREA (SLP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:RICHARD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 SOUTHWIND DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5476
Mailing Address - Country:US
Mailing Address - Phone:802-233-6704
Mailing Address - Fax:
Practice Address - Street 1:47 SOUTHWIND DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5476
Practice Address - Country:US
Practice Address - Phone:802-233-6704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT144.0116238235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12055901OtherAMERICAN SPEECH HEARING AND LANGUAGE ASSOCIATION CERTIFICATION
VT144.0116238OtherSTATE OF VERMONT SPEECH LANGUAGE PATHOLOGIST LICENSE