Provider Demographics
NPI:1952085896
Name:RICHARDSON, MEGAN LEIGH
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEIGH
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 1:11105 AMELINA LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-7650
Mailing Address - Country:US
Mailing Address - Phone:214-769-2910
Mailing Address - Fax:
Practice Address - Street 1:3550 PARKWOOD BLVD STE 704
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1920
Practice Address - Country:US
Practice Address - Phone:214-618-9341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116501235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty