Provider Demographics
NPI:1659465276
Name:LOFLIN, SANDY WILEY (LISW)
Entity Type:Individual
Prefix:MS
First Name:SANDY
Middle Name:WILEY
Last Name:LOFLIN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5204 ANDOVER DRIVE
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-6129
Mailing Address - Country:US
Mailing Address - Phone:440-845-9601
Mailing Address - Fax:440-740-1495
Practice Address - Street 1:8193 AVERY ROAD, SUITE 102
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-1671
Practice Address - Country:US
Practice Address - Phone:440-740-1495
Practice Address - Fax:440-740-1498
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI---88351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical