Healthcare Provider Details

I. General information

NPI: 1033314091
Provider Name (Legal Business Name): SHEREE S RICHARDSON AUDIOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 RIDGE RD SUITE E
MUNSTER IN
46321-1726
US

IV. Provider business mailing address

900 RIDGE RD SUITE E
MUNSTER IN
46321-1726
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-8408
  • Fax: 219-836-9656
Mailing address:
  • Phone: 219-836-8408
  • Fax: 219-836-9656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23001547A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: