Provider Demographics
NPI:1124310966
Name:RICHARDSON, AMBER MELISSA (MS)
Entity type:Individual
Prefix:MS
First Name:AMBER
Middle Name:MELISSA
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2028 PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-2519
Mailing Address - Country:US
Mailing Address - Phone:510-435-5727
Mailing Address - Fax:
Practice Address - Street 1:2208 CAMINO RAMON
Practice Address - Street 2:SUITE B
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1328
Practice Address - Country:US
Practice Address - Phone:925-362-0683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6785235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist