Healthcare Provider Details

I. General information

NPI: 1407750995
Provider Name (Legal Business Name): BOBBI ANN RICHARDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23738 LUJUAN DR
MILAN MO
63556-2802
US

IV. Provider business mailing address

373 S MARKET ST
MILAN MO
63556-1182
US

V. Phone/Fax

Practice location:
  • Phone: 660-265-8818
  • Fax:
Mailing address:
  • Phone: 660-265-4415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: