Healthcare Provider Details

I. General information

NPI: 1295573012
Provider Name (Legal Business Name): THE LOOM CONNECTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5725 ISABELLA AVE
TIMNATH CO
80547-4497
US

IV. Provider business mailing address

PO BOX 351
TIMNATH CO
80547-0351
US

V. Phone/Fax

Practice location:
  • Phone: 720-575-2318
  • Fax:
Mailing address:
  • Phone: 720-575-2318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. JESSICA LEE CORTEZ
Title or Position: SPEECH LANGUAGE PATHOLIGIST
Credential: MA, CCC-SLP, CBIS
Phone: 720-575-2318