Provider Demographics
NPI:1386933679
Name:LOPEZ-MEDINA, SONIA I (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:I
Last Name:LOPEZ-MEDINA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7703 GROMWELL CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-3128
Mailing Address - Country:US
Mailing Address - Phone:571-340-6704
Mailing Address - Fax:
Practice Address - Street 1:7703 GROMWELL CT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-3128
Practice Address - Country:US
Practice Address - Phone:571-340-6704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006273235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist