Provider Demographics
NPI:1326251679
Name:LOOP, NATASHA MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:MARIE
Last Name:LOOP
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68293 BUTLER STREET PO BOX 632
Mailing Address - Street 2:
Mailing Address - City:NEW PARIS
Mailing Address - State:IN
Mailing Address - Zip Code:46553
Mailing Address - Country:US
Mailing Address - Phone:574-831-6598
Mailing Address - Fax:
Practice Address - Street 1:1721 GREENCROFT BLVD
Practice Address - Street 2:GREENCROFT RETIREMENT CENTER
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526
Practice Address - Country:US
Practice Address - Phone:574-831-6598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004279A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist