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General NPI Number Information
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NPI Number | 1487932067
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Entity Type | Individual
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Provider Name | KIMBERLY ANNE LOOMIS M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 07/29/2011
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Last Update Date | 09/06/2019
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Provider Practice Location Address
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Address Line | 253 PLAZA DR STE C
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City | OVIEDO
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State | FL
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Zip | 32765-6460
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Country | US
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Telephone | 407-694-3603
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Fax | 321-296-7130
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Provider Business Mailing Address
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Address Line | 440 E RIVIERA BLVD
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City | INDIALANTIC
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State | FL
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Zip | 32903-4004
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Country | US
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Telephone | 321-272-0730
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA6418
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License Number State | FL
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