Provider Demographics
NPI:1528462785
Name:LIECHTY, ERIKA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:LIECHTY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 LONGFORD DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-2028
Mailing Address - Country:US
Mailing Address - Phone:586-883-1273
Mailing Address - Fax:
Practice Address - Street 1:174 LONGFORD DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-2028
Practice Address - Country:US
Practice Address - Phone:586-883-1273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101008229235Z00000X
CA23344235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist