Provider Demographics
NPI:1770852188
Name:RICHEY, ALICIA L (IBCLC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:L
Last Name:RICHEY
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-2106
Mailing Address - Country:US
Mailing Address - Phone:231-420-0518
Mailing Address - Fax:231-627-6756
Practice Address - Street 1:1504 E STATE ST
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-2106
Practice Address - Country:US
Practice Address - Phone:231-420-0518
Practice Address - Fax:231-627-6756
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator