Healthcare Provider Details

I. General information

NPI: 1083499768
Provider Name (Legal Business Name): LORETTA JEAN FARMER BA-SLP.,M.ED., R.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3724 RIEDHAM RD
SHAKER HEIGHTS OH
44120-5215
US

IV. Provider business mailing address

3724 RIEDHAM RD
SHAKER HEIGHTS OH
44120-5215
US

V. Phone/Fax

Practice location:
  • Phone: 216-820-3800
  • Fax:
Mailing address:
  • Phone: 216-820-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCW10003554
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: