Healthcare Provider Details

I. General information

NPI: 1760163539
Provider Name (Legal Business Name): STEPHANIE RICHARDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21630 RIDGETOP CIR STE 100
STERLING VA
20166-6564
US

IV. Provider business mailing address

46876 CLARION TER APT 100
STERLING VA
20164-1837
US

V. Phone/Fax

Practice location:
  • Phone: 571-449-6281
  • Fax:
Mailing address:
  • Phone: 805-630-1090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2204001203
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP200001700
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: