Provider Demographics
NPI:1376643940
Name:LOONEY, NANCY A (MS CCCSP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:LOONEY
Suffix:
Gender:F
Credentials:MS CCCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 RIDGEMONT DR
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-8846
Mailing Address - Country:US
Mailing Address - Phone:803-648-7784
Mailing Address - Fax:
Practice Address - Street 1:1135 RIDGEMONT DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-8846
Practice Address - Country:US
Practice Address - Phone:803-648-7784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC443235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0642Medicaid