Provider Demographics
NPI:1386050979
Name:RICHELSON, SHOSHANA DAHLIA (AUD)
Entity type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:DAHLIA
Last Name:RICHELSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:SHOSHANA
Other - Middle Name:DAHLIA
Other - Last Name:MOVSAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:29275 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1044
Mailing Address - Country:US
Mailing Address - Phone:248-356-7772
Mailing Address - Fax:248-356-7779
Practice Address - Street 1:29275 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 208
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1044
Practice Address - Country:US
Practice Address - Phone:248-356-7772
Practice Address - Fax:248-356-7779
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000687231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist