Provider Demographics
NPI:1881878619
Name:LOFTSGARD, SHERILYN MARIE (MS CF-SLP)
Entity type:Individual
Prefix:MRS
First Name:SHERILYN
Middle Name:MARIE
Last Name:LOFTSGARD
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:MS
Other - First Name:SHERILYN
Other - Middle Name:MARIE
Other - Last Name:KOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P O BOX 414
Mailing Address - Street 2:308 E 3RD ST
Mailing Address - City:MOSCOW MILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63362
Mailing Address - Country:US
Mailing Address - Phone:636-357-2601
Mailing Address - Fax:
Practice Address - Street 1:951 W COLLEGE
Practice Address - Street 2:TROY R-III
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-1112
Practice Address - Country:US
Practice Address - Phone:636-462-5081
Practice Address - Fax:636-528-2411
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007037026235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist