Provider Demographics
NPI:1427254044
Name:RICHARDSON, MICHELLE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
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 1:1333 ARCHWAY RD
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:24064-2138
Mailing Address - Country:US
Mailing Address - Phone:336-870-5259
Mailing Address - Fax:
Practice Address - Street 1:65 SHENANDOAH AVE STE 201
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24083-3205
Practice Address - Country:US
Practice Address - Phone:540-591-7514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC148NYOtherBCBS
NC7412919Medicaid