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1730050600 NPI number — PATRICIA ANN LIETZOW

NPI Number: 1730050600
Health Care Provider/Practitioner: PATRICIA ANN LIETZOW

Information about “1730050600” NPI (PATRICIA ANN LIETZOW) exists in 1730050600 in HTML format HTML  |  1730050600 in plain Text format TXT  |  1730050600 in PDF (Portable Document Format) PDF  |  1730050600 in an XML format XML  formats.

NPI Number : 1730050600 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1730050600",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LIETZOW",
    "FirstName": "PATRICIA",
    "MiddleName": "ANN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KING",
    "OtherFirstName": "PATRICIA",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "M.S.",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "14011 S HARRISON AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "POSEN",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60469-1025",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "708-772-0425",
    "MailingAddressFaxNumber": "708-388-3868",
    "FirstLinePracticeLocationAddress": "14011 S HARRISON AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "POSEN",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60469-1025",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "708-772-0425",
    "PracticeLocationAddressFaxNumber": "708-388-3868",
    "EnumerationDate": "09/15/2025",
    "LastUpdateDate": "09/15/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "1386745",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "1547614",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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