Provider Demographics
NPI:1912266016
Name:ANNE H LOUGHRIDGE, SPEECH-LANGUAGE PATHOLOGIST, PL
Entity Type:Organization
Organization Name:ANNE H LOUGHRIDGE, SPEECH-LANGUAGE PATHOLOGIST, PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:HALSTED
Authorized Official - Last Name:LOUGHRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:239-591-6641
Mailing Address - Street 1:1415 PANTHER LN
Mailing Address - Street 2:SUITE 240
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-7874
Mailing Address - Country:US
Mailing Address - Phone:239-591-6641
Mailing Address - Fax:239-591-6741
Practice Address - Street 1:1415 PANTHER LN
Practice Address - Street 2:SUITE 240
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-7874
Practice Address - Country:US
Practice Address - Phone:239-591-6641
Practice Address - Fax:239-591-6741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 125235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty