Individual
MR. MATTHEW WADE RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CCC-SLP
Contact information
Practice address
3205 JENNY LIND RD, FORT SMITH, AR 72901-7101
(479) 785-2501
Mailing address
9505 CHAD COLLEY BLVD APT 3111, FORT SMITH, AR 72916-5818
(801) 623-1921
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
200573
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A96010345
—
AZ
Enumeration date
08/31/2017
Last updated
08/30/2019
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