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NPI Code Detail

MEDICARE: PATTY RICHARDSON BSE, SLPA

MEDICARE:   PATTY  RICHARDSON  BSE, SLPA
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
12355S0801XSpeech-Language AssistantSLPA10879AZ

General Provider Information

NPI Number : 1467964452
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATTY RICHARDSON BSE, SLPA
Provider Business Mailing Address
First Line : 5229 W DESERT COVE AVE
Second Line :
City : GLENDALE
State : AZ
Zip : 85304-4224
Country : US
Telephone Number : 623-606-7177
Fax Number :
Provider Business Practice Location Address
First Line : 5229 W DESERT COVE AVE
Second Line :
City : GLENDALE
State : AZ
Zip : 85304-4224
Country : US
Telephone Number : 623-606-7177
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2017
Last Update Date : 10/30/2017

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Directions to “ PATTY RICHARDSON BSE, SLPA” Practice Location

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