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General NPI Number Information
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NPI Number | 1083065288
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Entity Type | Organization
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Legal Business Name | JESSICA RICHARDS SPEECH THERAPY
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Dates
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Enumeration Date | 06/29/2016
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Last Update Date | 06/30/2016
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Provider Practice Location Address
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Address Line | 126 ATLANTA ST
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City | PADUCAH
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State | KY
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Zip | 42003-5508
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Country | US
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Telephone | 270-519-0257
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Fax |
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Provider Business Mailing Address
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Address Line | 126 ATLANTA ST
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City | PADUCAH
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State | KY
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Zip | 42003-5508
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Country | US
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Telephone | 270-519-0257
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | MS. JESSICA ELLEN RICHARDS
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Credential | M.S. CCC-SLP
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Telephone | 270-519-0257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | KY4405
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License Number State | KY
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