Provider Demographics
NPI:1215357140
Name:RICHARDSON, LAURA FRANCES (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:FRANCES
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 TEABERRY LN APT A12
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-2824
Mailing Address - Country:US
Mailing Address - Phone:610-823-5195
Mailing Address - Fax:
Practice Address - Street 1:1051 TEABERRY LN APT A12
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2824
Practice Address - Country:US
Practice Address - Phone:610-823-5195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL011363235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist