Provider Demographics
NPI:1699899153
Name:RICHARDSON, BRENDA SUE (MAE/IECE, DI)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:SUE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MAE/IECE, DI
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:MELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3497 NEW SALEM ROAD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-9471
Mailing Address - Country:US
Mailing Address - Phone:270-678-7555
Mailing Address - Fax:270-678-7558
Practice Address - Street 1:3497 NEW SALEM ROAD
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-9471
Practice Address - Country:US
Practice Address - Phone:270-678-7555
Practice Address - Fax:270-678-7555
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1478OtherCABINET FOR HLTH & FAMILY