Provider Demographics
NPI:1740388727
Name:LOONEY, LIESL RHENATA PERRY (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:LIESL
Middle Name:RHENATA PERRY
Last Name:LOONEY
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 ROCKLAND RD
Mailing Address - Street 2:AUDIOLOGY DEPARTMENT
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3607
Mailing Address - Country:US
Mailing Address - Phone:302-651-6052
Mailing Address - Fax:302-651-6219
Practice Address - Street 1:1600 ROCKLAND RD
Practice Address - Street 2:AUDIOLOGY DEPARTMENT
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3607
Practice Address - Country:US
Practice Address - Phone:302-651-6052
Practice Address - Fax:302-651-6219
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA-0170231H00000X
DE231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3404005000Medicaid
WVPE4040631Medicare ID - Type Unspecified
WV3404005000Medicaid