Individual
HOLLIE LYNN LIETZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
38777 6 MILE RD, LIVONIA, MI 48152-2694
(734) 452-0395
Mailing address
30995 LAKEVIEW BLVD APT 7105, WIXOM, MI 48393-2858
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
5502003547
MI
Other
Enumeration date
04/11/2013
Last updated
04/11/2013
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