Provider Demographics
NPI:1528130622
Name:RICHARDSON, JOCELYN SUZANNE (MA, CCC,SLP)
Entity type:Individual
Prefix:MRS
First Name:JOCELYN
Middle Name:SUZANNE
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:PO BOX 1502
Mailing Address - Street 2:6646 U.S. HWY 19
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34656-1502
Mailing Address - Country:US
Mailing Address - Phone:727-848-6747
Mailing Address - Fax:727-847-3107
Practice Address - Street 1:38051 PASCO AVE
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-4234
Practice Address - Country:US
Practice Address - Phone:727-848-6747
Practice Address - Fax:727-847-3107
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6269235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist