Provider Demographics
NPI:1346360799
Name:DMUCHOSKI WRIGHT, ERICA L (AUD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:L
Last Name:DMUCHOSKI WRIGHT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:L
Other - Last Name:DMUCHOSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:PO BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-6153
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4301 CANAL AVE SW
Practice Address - Street 2:SUITE #203
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2667
Practice Address - Country:US
Practice Address - Phone:616-257-7880
Practice Address - Fax:616-257-0580
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000446231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1601000446OtherAUDIOLOGIST LICENSE