Basic Information
| Provider Information | |||||||||
| NPI: | 1396911244 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICHARDS | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | B | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6420 DUTCHMANS PKWY | ||||||||
| Address2: | SUITE 380 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402053372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028949753 | ||||||||
| FaxNumber: | 5023710929 | ||||||||
| Practice Location | |||||||||
| Address1: | 6420 DUTCHMANS PKWY | ||||||||
| Address2: | #380 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402053372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028949753 | ||||||||
| FaxNumber: | 5023710929 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2008 | ||||||||
| LastUpdateDate: | 12/03/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | KY-0485 | KY | Y | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | KY-0949 | KY | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.