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General NPI Number Information
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NPI Number | 1962956474
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Entity Type | Individual
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Provider Name | BREANNA RICHARDSON SLP
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Gender | Female
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Dates
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Enumeration Date | 08/12/2016
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Last Update Date | 03/01/2022
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Provider Practice Location Address
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Address Line | 2030 CHILHOWEE MEDICAL PARK
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City | MARYVILLE
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State | TN
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Zip | 37804-5285
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Country | US
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Telephone | 865-982-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 2279 ATKINSON RD
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City | BILOXI
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State | MS
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Zip | 39531-2209
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Country | US
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Telephone | 228-388-1805
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 4067
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | S3878
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 6742
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License Number State | TN
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