Healthcare Provider Details

I. General information

NPI: 1992419675
Provider Name (Legal Business Name): VICKIE D RICHARDS M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1154 SAW MILL RIVER RD
YONKERS NY
10710-3210
US

IV. Provider business mailing address

1375 BURKE AVE
BRONX NY
10469-3008
US

V. Phone/Fax

Practice location:
  • Phone: 914-968-4854
  • Fax:
Mailing address:
  • Phone: 646-251-5571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number032361
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: