Healthcare Provider Details

I. General information

NPI: 1487932067
Provider Name (Legal Business Name): KIMBERLY ANNE LOOMIS M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3270 SUNTREE BLVD
MELBOURNE FL
32940-7530
US

IV. Provider business mailing address

440 E RIVIERA BLVD
INDIALANTIC FL
32903-4004
US

V. Phone/Fax

Practice location:
  • Phone: 833-684-5439
  • Fax:
Mailing address:
  • Phone: 321-272-0730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA6418
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: