Provider Demographics
NPI:1558247171
Name:RICHARDS, JENNIFER A (ORTON-GILLINGHAM)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:ORTON-GILLINGHAM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 RIVERVIEW TER
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-6959
Mailing Address - Country:US
Mailing Address - Phone:330-842-7416
Mailing Address - Fax:
Practice Address - Street 1:39 RIVERVIEW TER
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-6959
Practice Address - Country:US
Practice Address - Phone:330-842-7416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3399392062251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)