Provider Demographics
NPI:1932745247
Name:RICHARDSON, JANIS JORDAN
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:JORDAN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 S WOODBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-4106
Mailing Address - Country:US
Mailing Address - Phone:434-251-4847
Mailing Address - Fax:
Practice Address - Street 1:746 INDIAN TRL
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-4520
Practice Address - Country:US
Practice Address - Phone:582-040-3276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist