Provider Demographics
NPI:1033761226
Name:MCKITTRICK, LORING (MA)
Entity Type:Individual
Prefix:
First Name:LORING
Middle Name:
Last Name:MCKITTRICK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:LORING
Other - Middle Name:
Other - Last Name:SHELBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7475 HARDSCRAPPLE DR APT B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-1344
Mailing Address - Country:US
Mailing Address - Phone:314-399-5091
Mailing Address - Fax:
Practice Address - Street 1:2745 MERAMEC ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-4533
Practice Address - Country:US
Practice Address - Phone:314-353-7145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019019655235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist