Provider Demographics
NPI:1912102799
Name:RICHARDSON, ERIN YOUNG (MA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:YOUNG
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13311 TUCKER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-4581
Mailing Address - Country:US
Mailing Address - Phone:502-370-6703
Mailing Address - Fax:502-688-6659
Practice Address - Street 1:13311 TUCKER LAKE DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-4581
Practice Address - Country:US
Practice Address - Phone:502-370-6703
Practice Address - Fax:502-688-6659
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
KY138650235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist