MEDICARE: MARY L RICHARDSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1467192690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY L RICHARDSON

Provider Business Mailing Address
First Line	:	2626 LINCOLN DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-3606
Country	:	US
Telephone Number	:	682-867-3623
Fax Number	:

Provider Business Practice Location Address
First Line	:	2626 LINCOLN DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-3606
Country	:	US
Telephone Number	:	682-867-3623
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2022
Last Update Date	:	03/29/2022

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Directions to “ MARY L RICHARDSON ” Practice Location

Language	Start Address	Practice Location

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