Individual
CHANEL LANETE RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
1986 NORTHPORT RD APT 2, CORDOVA, TN 38016-3880
(317) 937-6874
Mailing address
1389 TURKINGTON CT, GREENWOOD, IN 46143-5518
(317) 937-6874
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
26029048A
IN
235Z00000X
Speech-Language Pathologist
Primary
SP 0000004526
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26029048A
PHARMACIST
IN
01
—
SP 0000004526
TENNESSEE STATE LICENSE FOR SPEECH LANGUAGE PATHOLOGY
TN
Enumeration date
02/18/2013
Last updated
12/18/2020
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