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General NPI Number Information
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NPI Number | 1730050600
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Entity Type | Individual
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Provider Name | PATRICIA ANN LIETZOW
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Gender | Female
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Dates
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Enumeration Date | 09/15/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 14011 S HARRISON AVE
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City | POSEN
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State | IL
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Zip | 60469-1025
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Country | US
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Telephone | 708-772-0425
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Fax | 708-388-3868
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Provider Business Mailing Address
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Address Line | 14011 S HARRISON AVE
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City | POSEN
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State | IL
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Zip | 60469-1025
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Country | US
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Telephone | 708-772-0425
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Fax | 708-388-3868
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 1386745
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 1547614
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License Number State | IN
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