Provider Demographics
NPI:1205259322
Name:LICATA, KELI EILEEN RULF (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELI
Middle Name:EILEEN RULF
Last Name:LICATA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:KELI
Other - Middle Name:EILEEN
Other - Last Name:RULF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 CATHERINE ST
Mailing Address - Street 2:UNIV. CENTER FOR DEVELOPMENT OF LANGUAGE & LITERACY
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-2054
Mailing Address - Country:US
Mailing Address - Phone:734-764-8440
Mailing Address - Fax:
Practice Address - Street 1:1111 CATHERINE ST
Practice Address - Street 2:UNIV. CENTER FOR DEVELOPMENT OF LANGUAGE & LITERACY
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-2054
Practice Address - Country:US
Practice Address - Phone:734-764-8440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101000788235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist