Healthcare Provider Details

I. General information

NPI: 1205180296
Provider Name (Legal Business Name): LOREN KUPPELMEYER MS,CCC/LSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 WOODWARD PARKWAY FARMINGDALE SCHOOL DISTRICT
FARMINGDALE NY
11735-5233
US

IV. Provider business mailing address

110 RADCLIFFE AVE
FARMINGDALE NY
11735-5223
US

V. Phone/Fax

Practice location:
  • Phone: 516-752-6560
  • Fax:
Mailing address:
  • Phone: 516-249-9016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number005845-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: