Provider Demographics
NPI:1851682462
Name:PRICHARD, TIMOTHY CLIFTON (MA)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:CLIFTON
Last Name:PRICHARD
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5770 TIMBER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-3025
Mailing Address - Country:US
Mailing Address - Phone:814-572-0464
Mailing Address - Fax:
Practice Address - Street 1:5770 TIMBER LAKE DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243
Practice Address - Country:US
Practice Address - Phone:814-572-0464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ5227235Z00000X
FLSA11443235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist