Healthcare Provider Details

I. General information

NPI: 1699588814
Provider Name (Legal Business Name): LOREN SAMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 HUDGINS ST UNIT 143
LOGAN WV
25601-3535
US

IV. Provider business mailing address

PO BOX 143
MAN WV
25635-0143
US

V. Phone/Fax

Practice location:
  • Phone: 304-688-8911
  • Fax:
Mailing address:
  • Phone: 304-688-8434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: