Provider Demographics
NPI:1699493817
Name:LOFTIN, LEAH GABRIELLE
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:GABRIELLE
Last Name:LOFTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 SHERIFF RD NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-3760
Mailing Address - Country:US
Mailing Address - Phone:301-659-4560
Mailing Address - Fax:
Practice Address - Street 1:447 TENNESSEE AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-5433
Practice Address - Country:US
Practice Address - Phone:202-995-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty