Individual
MS. AMANDA RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
CHILDREN'S DEVELOPMENTAL SERVICES AGENCY - DEPT OF PED, IRONS BUILDING - OGLESBY DR., GREENVILLE, NC 27858
(252) 737-1177
Mailing address
PO BOX 751069, CHARLOTTE, NC 28275-1069
(252) 744-3253
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5757
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
139EN
BCBS NC
NC
Enumeration date
11/07/2006
Last updated
07/08/2007
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