Healthcare Provider Details

I. General information

NPI: 1144349242
Provider Name (Legal Business Name): CARRIE DENISE LOUGHRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4680 LAKE UNDERHILL RD
ORLANDO FL
32807-1182
US

IV. Provider business mailing address

265 LIVERPOOL CV
LONGWOOD FL
32779-5638
US

V. Phone/Fax

Practice location:
  • Phone: 407-852-3300
  • Fax:
Mailing address:
  • Phone: 407-415-4026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI 955
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA10514
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: