Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PY01083 | MO |
N | 103TC0700X | Clinical Psychologist | PY01083 | MO |
N | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1053381087 |
---|---|
Provider Name | Ellen Q. Richardson |
First Address | Springfield, MO 65804-7216 |
Second Address | Springfield, MO 65804-7216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 09/07/2007 |