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General NPI Number Information
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NPI Number | 1306538244
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Entity Type | Organization
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Legal Business Name | LOOMA
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 6906 PAIUTE CIR
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City | EDINA
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State | MN
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Zip | 55439-1031
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Country | US
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Telephone | 612-508-0704
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Fax |
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Provider Business Mailing Address
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Address Line | 6906 PAIUTE CIR
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City | EDINA
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State | MN
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Zip | 55439-1031
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Country | US
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Telephone | 612-508-0704
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LEAH PILLSBURY
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Credential | MSW
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Telephone | 612-710-2561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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