Provider Demographics
NPI:1205278959
Name:RICHARDSON, SUSAN LYNN
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LYNN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 PARKERS MILL RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-3152
Mailing Address - Country:US
Mailing Address - Phone:606-678-2821
Mailing Address - Fax:
Practice Address - Street 1:259 PARKERS MILL RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-3152
Practice Address - Country:US
Practice Address - Phone:606-678-2821
Practice Address - Fax:606-679-7252
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY201066651222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist