Provider Demographics
NPI:1356865851
Name:RICKEY, LAURA (AUD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:RICKEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 MONROE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3043
Mailing Address - Country:US
Mailing Address - Phone:313-552-4100
Mailing Address - Fax:313-562-4590
Practice Address - Street 1:2421 MONROE ST STE 201
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3043
Practice Address - Country:US
Practice Address - Phone:313-552-4100
Practice Address - Fax:313-562-4590
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000785237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter