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General NPI Number Information
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NPI Number | 1821686379
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Entity Type | Organization
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Legal Business Name | LEARNING LOFT
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Dates
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Enumeration Date | 01/08/2021
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Last Update Date | 05/11/2021
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Provider Practice Location Address
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Address Line | 1185 LANE AVE S STE 2
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City | JACKSONVILLE
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State | FL
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Zip | 32205-6208
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Country | US
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Telephone | 904-210-2885
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 433
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City | LOUGHMAN
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State | FL
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Zip | 33858-0433
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Country | US
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Telephone | 904-210-2885
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | MISS SELLERS A SHANTE
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Credential | MS.CCC-SLP
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Telephone | 904-210-2885
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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 |
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License Number State |
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