Provider Demographics
NPI:1295573012
Name:THE LOOM CONNECTION, LLC
Entity type:Organization
Organization Name:THE LOOM CONNECTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLIGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CORTEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP, CBIS
Authorized Official - Phone:720-575-2318
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:TIMNATH
Mailing Address - State:CO
Mailing Address - Zip Code:80547-0351
Mailing Address - Country:US
Mailing Address - Phone:720-575-2318
Mailing Address - Fax:
Practice Address - Street 1:5725 ISABELLA AVE
Practice Address - Street 2:
Practice Address - City:TIMNATH
Practice Address - State:CO
Practice Address - Zip Code:80547-4497
Practice Address - Country:US
Practice Address - Phone:720-575-2318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech