Provider Demographics
NPI:1083499768
Name:FARMER, LORETTA JEAN (BA-SLP,MED, RS)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:JEAN
Last Name:FARMER
Suffix:
Gender:F
Credentials:BA-SLP,MED, RS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3724 RIEDHAM RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-5215
Mailing Address - Country:US
Mailing Address - Phone:216-820-3800
Mailing Address - Fax:
Practice Address - Street 1:13125 SHAKER SQ STE 202
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-2399
Practice Address - Country:US
Practice Address - Phone:216-820-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty