Provider Demographics
NPI:1326210642
Name:LUETTICH, ERIN RENEE (AUD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:RENEE
Last Name:LUETTICH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:RENEE
Other - Last Name:VIDES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:39 BARKLEY CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7531
Mailing Address - Country:US
Mailing Address - Phone:239-936-1616
Mailing Address - Fax:
Practice Address - Street 1:39 BARKLEY CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7531
Practice Address - Country:US
Practice Address - Phone:239-936-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1292231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist