Provider Demographics
NPI:1851810485
Name:RICHARD, KALIE SARAH
Entity type:Individual
Prefix:
First Name:KALIE
Middle Name:SARAH
Last Name:RICHARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KALIE
Other - Middle Name:SARAH
Other - Last Name:MADDOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3435 E DUBLIN ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-3509
Mailing Address - Country:US
Mailing Address - Phone:480-627-9034
Mailing Address - Fax:
Practice Address - Street 1:3435 E DUBLIN ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-3509
Practice Address - Country:US
Practice Address - Phone:480-627-9034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP12674235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist