Provider Demographics
NPI:1245619386
Name:RICHCREEK, KIESHA (LC)
Entity type:Individual
Prefix:
First Name:KIESHA
Middle Name:
Last Name:RICHCREEK
Suffix:
Gender:F
Credentials:LC
Other - Prefix:
Other - First Name:KIKI
Other - Middle Name:
Other - Last Name:RICHCREEK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LC
Mailing Address - Street 1:2781 WOODLAKE RD SW
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-4645
Mailing Address - Country:US
Mailing Address - Phone:616-710-8678
Mailing Address - Fax:616-608-3869
Practice Address - Street 1:2781 WOODLAKE RD SW
Practice Address - Street 2:SUITE 6
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-4645
Practice Address - Country:US
Practice Address - Phone:616-710-8678
Practice Address - Fax:616-608-3869
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174V00000XOther Service ProvidersClinical Ethicist