Provider Demographics
NPI:1821686379
Name:LEARNING LOFT
Entity Type:Organization
Organization Name:LEARNING LOFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:SELLERS
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHANTE
Authorized Official - Suffix:
Authorized Official - Credentials:MSCCC-SLP
Authorized Official - Phone:904-210-2885
Mailing Address - Street 1:PO BOX 433
Mailing Address - Street 2:
Mailing Address - City:LOUGHMAN
Mailing Address - State:FL
Mailing Address - Zip Code:33858-0433
Mailing Address - Country:US
Mailing Address - Phone:904-210-2885
Mailing Address - Fax:
Practice Address - Street 1:1185 LANE AVE S STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-6208
Practice Address - Country:US
Practice Address - Phone:904-210-2885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-08
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty