MEDICARE: KARA RICHELLE 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	104100000X	Social Worker	S.2004798	OH

General Provider Information

NPI Number	:	1669966917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARA RICHELLE RICHARDSON

Provider Business Mailing Address
First Line	:	336 KENT DR
Second Line	:
City	:	TALLMADGE
State	:	OH
Zip	:	44278-1422
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4243 HIGBEE AVE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-4471
Country	:	US
Telephone Number	:	330-701-0184
Fax Number	:

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

Provider Enumeration Date	:	06/20/2018
Last Update Date	:	05/08/2020

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Directions to “ KARA RICHELLE RICHARDSON ” Practice Location

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