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General NPI Number Information
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NPI Number | 1750634820
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Entity Type | Organization
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Legal Business Name | LOOBYLOO THERAPY SERVICES
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Dates
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Enumeration Date | 10/25/2012
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Last Update Date | 10/25/2012
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Provider Practice Location Address
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Address Line | 113 WOODBERRY
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City | CROSSETT
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State | AR
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Zip | 71635-3926
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Country | US
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Telephone | 870-224-3585
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Fax | 870-304-2595
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Provider Business Mailing Address
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Address Line | 113 WOODBERRY
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City | CROSSETT
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State | AR
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Zip | 71635-3926
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Country | US
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Telephone | 870-224-3585
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Fax | 870-304-2595
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | MRS. CANDICE DIANE REED
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Credential | M.S., CCC-SLP
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Telephone | 870-224-3585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | SP#2375
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License Number State | AR
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