Provider Demographics
NPI:1942477690
Name:MCLOUGHLIN, JEAN E (MED)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:E
Last Name:MCLOUGHLIN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17745 GRANDE BAYOU CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-6124
Mailing Address - Country:US
Mailing Address - Phone:239-433-2288
Mailing Address - Fax:
Practice Address - Street 1:17745 GRANDE BAYOU CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-6124
Practice Address - Country:US
Practice Address - Phone:239-433-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4395235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL884197700Medicaid