Basic Information
| Provider Information | |||||||||
| NPI: | 1770055576 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FECTEAU | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | MACCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50598 COMMONS DR | ||||||||
| Address2: | |||||||||
| City: | MACOMB | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480424638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485081144 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1410 E 14 MILE RD | ||||||||
| Address2: | |||||||||
| City: | MADISON HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480711541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487439500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2018 | ||||||||
| LastUpdateDate: | 12/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 7101003050 | MI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.