Provider Demographics
NPI:1841265055
Name:RICHEY, LISA C (AUD)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:C
Last Name:RICHEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3729
Mailing Address - Country:US
Mailing Address - Phone:501-778-3868
Mailing Address - Fax:
Practice Address - Street 1:5 MEDICAL PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3729
Practice Address - Country:US
Practice Address - Phone:501-778-3868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA#77231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR114162720Medicaid
AR621697738OtherTAX ID #
AR59038Medicare ID - Type Unspecified
ARS41211Medicare UPIN