Individual
JESSICA RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, CCC-SLP
Contact information
Practice address
1700 LOMAS BLVD NE STE 1300, ALBUQUERQUE, NM 87106-3835
(505) 277-4453
Mailing address
800 BRADBURY DR SE STE 116, ALBUQUERQUE, NM 87106-4310
(505) 272-1476
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
SLP006147
GA
235Z00000X
Speech-Language Pathologist
Primary
SLP6779
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12057372
ASHA CERTIFIED MEMBER
—
01
—
SLP6779
NEW MEXICO REGULATION AND LICENSING DEPARTMENT
NM
Enumeration date
03/23/2007
Last updated
10/11/2024
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