Provider Demographics
NPI:1699067801
Name:LOFLAND, KRISTIN JESSICA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JESSICA
Last Name:LOFLAND
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:JESSICA
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLPA
Mailing Address - Street 1:11955 W MESQUITE DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-0813
Mailing Address - Country:US
Mailing Address - Phone:208-869-9737
Mailing Address - Fax:
Practice Address - Street 1:11955 W MESQUITE DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-0813
Practice Address - Country:US
Practice Address - Phone:208-869-9737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP2591235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist