Provider Demographics
NPI:1770055576
Name:FECTEAU, KAREN ELIZABETH (MACCC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ELIZABETH
Last Name:FECTEAU
Suffix:
Gender:F
Credentials:MACCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50598 COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-4638
Mailing Address - Country:US
Mailing Address - Phone:248-508-1144
Mailing Address - Fax:
Practice Address - Street 1:1410 E 14 MILE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1541
Practice Address - Country:US
Practice Address - Phone:248-743-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101003050235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist