Provider Demographics
NPI:1992419675
Name:RICHARDS, VICKIE D (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:VICKIE
Middle Name:D
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 BURKE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-3008
Mailing Address - Country:US
Mailing Address - Phone:646-251-5571
Mailing Address - Fax:
Practice Address - Street 1:1154 SAW MILL RIVER RD
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-3210
Practice Address - Country:US
Practice Address - Phone:914-968-4854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032361235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist