Provider Demographics
NPI:1366680605
Name:LOBODZINSKI, RICHELLE (MACC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:RICHELLE
Middle Name:
Last Name:LOBODZINSKI
Suffix:
Gender:F
Credentials:MACC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 W LIVINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48357-4624
Mailing Address - Country:US
Mailing Address - Phone:248-310-9762
Mailing Address - Fax:
Practice Address - Street 1:337 W LIVINGSTON RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:MI
Practice Address - Zip Code:48357-4624
Practice Address - Country:US
Practice Address - Phone:248-310-9762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-24
Last Update Date:2009-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12011929235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist