Provider Demographics
NPI:1457595852
Name:LOFTUS, AMBER JEAN (BA, LBSW, QMRP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:JEAN
Last Name:LOFTUS
Suffix:
Gender:F
Credentials:BA, LBSW, QMRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-8195
Mailing Address - Country:US
Mailing Address - Phone:269-650-1811
Mailing Address - Fax:
Practice Address - Street 1:277 NORTH ST
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-1138
Practice Address - Country:US
Practice Address - Phone:269-673-5092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802082303171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator