Provider Demographics
NPI:1437500436
Name:LOAFMAN, SAVANNA (LLP)
Entity Type:Individual
Prefix:
First Name:SAVANNA
Middle Name:
Last Name:LOAFMAN
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 TORREY RD STE E
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-1340
Mailing Address - Country:US
Mailing Address - Phone:810-449-8325
Mailing Address - Fax:810-885-0695
Practice Address - Street 1:1440 TORREY RD STE E
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430
Practice Address - Country:US
Practice Address - Phone:810-449-8325
Practice Address - Fax:108-850-6958
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016717103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist