Provider Demographics
NPI:1306095187
Name:RICHARDS, JAN MARIE (HIS)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:MARIE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 W VILLARD ST
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-4843
Mailing Address - Country:US
Mailing Address - Phone:701-227-4403
Mailing Address - Fax:701-483-4405
Practice Address - Street 1:925 W VILLARD ST
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4843
Practice Address - Country:US
Practice Address - Phone:701-227-4403
Practice Address - Fax:701-483-4405
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2004482355A2700X, 237700000X
NDH-0313237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology Assistant