Provider Demographics
NPI:1154608750
Name:LETIZIO, AMY
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:LETIZIO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:RUMPL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14210 MORTENVIEW DR.
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180
Mailing Address - Country:US
Mailing Address - Phone:586-489-6950
Mailing Address - Fax:734-525-4020
Practice Address - Street 1:25882 ORCHARD LAKE RD. #103
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336
Practice Address - Country:US
Practice Address - Phone:248-671-6310
Practice Address - Fax:734-525-4020
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501004828237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist