Provider Demographics
NPI:1932627445
Name:LEROUX, RICHARD (BC-HIS)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:LEROUX
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 W AUSTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-3716
Mailing Address - Country:US
Mailing Address - Phone:417-667-5566
Mailing Address - Fax:
Practice Address - Street 1:1505 W AUSTIN BLVD
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-3716
Practice Address - Country:US
Practice Address - Phone:417-667-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015030843237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist