Provider Demographics
NPI:1316489479
Name:RICHARDSON, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BANK ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 BANK ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4407
Practice Address - Country:US
Practice Address - Phone:406-532-2935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744G0900XOther Service ProvidersSpecialistGraphics Designer