Individual
BROOKE RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
111 GLEASON ST, GOUVERNEUR, NY 13642-1217
(315) 528-8740
Mailing address
287 DENNIS RD, LISBON, NY 13658-4219
(315) 528-5870
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
031958
NY
Other
Enumeration date
09/08/2022
Last updated
09/08/2022
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