Individual
LISA LOOSLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ED.S.
Contact information
Practice address
529 NW PRIMA VISTA BLVD STE 301L, PORT ST LUCIE, FL 34983-8790
(772) 404-2122
Mailing address
1530 W ANN TAYLOR ST APT M101, MERIDIAN, ID 83646-4022
(208) 494-4487
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
1768
FL
Other
Enumeration date
04/18/2023
Last updated
04/18/2023
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