Provider Demographics
NPI:1487908844
Name:RICHARDSON, JON M (HEARING SPECIALIST)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:M
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:HEARING SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-2819
Mailing Address - Country:US
Mailing Address - Phone:828-322-9323
Mailing Address - Fax:828-322-4166
Practice Address - Street 1:102 ELKIN HWY
Practice Address - Street 2:SUITE #E
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3468
Practice Address - Country:US
Practice Address - Phone:336-838-8886
Practice Address - Fax:336-838-8886
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC698A01237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist