MEDICARE: KERRY LYNN RICHMAN M.S., CCC-SLP

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	4765	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12889	OTHER	NC	BLUECROSSBLUESHIELD
2	7648723	OTHER	NC	AETNA

General Provider Information

NPI Number	:	1699803817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRY LYNN RICHMAN M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	1620 BATSON CREEK LN
Second Line	:
City	:	WEDDINGTON
State	:	NC
Zip	:	28104-0062
Country	:	US
Telephone Number	:	704-578-3023
Fax Number	:

Provider Business Practice Location Address
First Line	:	7301 CARMEL EXECUTIVE PARK DR
Second Line	:	SUITE 302
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-8251
Country	:	US
Telephone Number	:	704-540-3777
Fax Number	:	704-540-1443

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	04/03/2024

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