Provider Demographics
NPI:1184840092
Name:HOOYMAN, LOREN ANTONE
Entity Type:Individual
Prefix:MR
First Name:LOREN
Middle Name:ANTONE
Last Name:HOOYMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 W 44TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1032
Mailing Address - Country:US
Mailing Address - Phone:952-215-1452
Mailing Address - Fax:952-922-1980
Practice Address - Street 1:3919 W 44TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1032
Practice Address - Country:US
Practice Address - Phone:952-215-1452
Practice Address - Fax:952-922-1980
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLPO532103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist