Individual
MRS. MICHELE JAYNE RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
6905 NW 122ND ST, OKLAHOMA CITY, OK 73142-3903
(405) 603-6622
Mailing address
2708 JACLYNS TRL, EDMOND, OK 73012-4319
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3435
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12132768
ASHA
—
01
—
3435
OBESPA
OK
Enumeration date
10/24/2018
Last updated
10/24/2018
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