Provider Demographics
NPI:1972762441
Name:LOUGHLIN, MARY JO THERESA (MS, CCC-SLP)
Entity Type:Individual
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First Name:MARY JO
Middle Name:THERESA
Last Name:LOUGHLIN
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Gender:F
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:2805 EVE ANN DR
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-4288
Mailing Address - Country:US
Mailing Address - Phone:631-678-2216
Mailing Address - Fax:631-678-2216
Practice Address - Street 1:125 E BETHPAGE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4228
Practice Address - Country:US
Practice Address - Phone:516-731-5588
Practice Address - Fax:516-567-9049
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2014-01-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY018103-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist