Provider Demographics
NPI:1194132118
Name:LOPEZ, BETH (SLP/CCC)
Entity type:Individual
Prefix:
First Name:BETH
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 1:2611 FM 1960 RD W
Mailing Address - Street 2:SUITE B-100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77068-3731
Mailing Address - Country:US
Mailing Address - Phone:281-377-0770
Mailing Address - Fax:281-377-0775
Practice Address - Street 1:2611 FM 1960 RD W
Practice Address - Street 2:SUITE B-100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3731
Practice Address - Country:US
Practice Address - Phone:281-377-0770
Practice Address - Fax:281-377-0775
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106469235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist