Provider Demographics
NPI:1750634820
Name:LOOBYLOO THERAPY SERVICES
Entity Type:Organization
Organization Name:LOOBYLOO THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:870-224-3585
Mailing Address - Street 1:113 WOODBERRY
Mailing Address - Street 2:
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635-3926
Mailing Address - Country:US
Mailing Address - Phone:870-224-3585
Mailing Address - Fax:870-304-2595
Practice Address - Street 1:113 WOODBERRY
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-3926
Practice Address - Country:US
Practice Address - Phone:870-224-3585
Practice Address - Fax:870-304-2595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2375252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1104033059OtherPERSONAL NPI NUMBER
AR162452721Medicaid