MEDICARE: CHRISTA LYNN RICHBOURG ST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	100334	TX

General Provider Information

NPI Number	:	1902058076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTA LYNN RICHBOURG ST

Provider Business Mailing Address
First Line	:	656 ACR 167
Second Line	:
City	:	ELKHART
State	:	TX
Zip	:	75839
Country	:	US
Telephone Number	:	903-279-5478
Fax Number	:

Provider Business Practice Location Address
First Line	:	1007 E PARK AVE
Second Line	:
City	:	PALESTINE
State	:	TX
Zip	:	75801-4500
Country	:	US
Telephone Number	:	903-731-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	09/27/2022

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Directions to “ CHRISTA LYNN RICHBOURG ST” Practice Location

Language	Start Address	Practice Location

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