Provider Demographics
NPI:1417306457
Name:LOOMIS, ROCHELLE ELIZABETH (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:ELIZABETH
Last Name:LOOMIS
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 1:9573 ALVARADO LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-1151
Mailing Address - Country:US
Mailing Address - Phone:612-719-5318
Mailing Address - Fax:
Practice Address - Street 1:7767 ELM CREEK BLVD N
Practice Address - Street 2:SUITE 100
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7041
Practice Address - Country:US
Practice Address - Phone:763-416-8715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8240235Z00000X
GASLP009297235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist