Provider Demographics
NPI:1932451564
Name:RICHARDSON, ALAN RAY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:RAY
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:3331 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:THATCHER
Mailing Address - State:AZ
Mailing Address - Zip Code:85552-5628
Mailing Address - Country:US
Mailing Address - Phone:928-890-7501
Mailing Address - Fax:928-348-3868
Practice Address - Street 1:1600 S 20TH AVE
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-4011
Practice Address - Country:US
Practice Address - Phone:928-651-5454
Practice Address - Fax:928-348-3868
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZTSLP8007235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist