Provider Demographics
NPI:1104098375
Name:LOPEZ, MICHELLE (SLP-CCC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 N. 77 SUNSHINE STRIP
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8847
Mailing Address - Country:US
Mailing Address - Phone:956-421-4667
Mailing Address - Fax:956-421-2016
Practice Address - Street 1:302 KINGS HWY STE 208
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-4225
Practice Address - Country:US
Practice Address - Phone:956-550-8200
Practice Address - Fax:956-550-8133
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist