Provider Demographics
NPI:1902916737
Name:LIND, RICHARD CHARLES (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:CHARLES
Last Name:LIND
Suffix:
Gender:M
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 LIVE OAK BLVD STE A3
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3454
Mailing Address - Country:US
Mailing Address - Phone:530-755-4155
Mailing Address - Fax:530-790-7141
Practice Address - Street 1:1007 LIVE OAK BLVD STE A3
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3454
Practice Address - Country:US
Practice Address - Phone:530-755-4155
Practice Address - Fax:530-790-7141
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU402231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0004020Medicaid
CAAU0004020Medicaid