Provider Demographics
NPI:1407591563
Name:LOPEZ, ALICE D
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:D
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:D
Other - Last Name:CACERES-TURCIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1341 SOUTH ST APT 19
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1938
Mailing Address - Country:US
Mailing Address - Phone:224-507-2636
Mailing Address - Fax:
Practice Address - Street 1:5400 W ELM ST STE 104
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4032
Practice Address - Country:US
Practice Address - Phone:847-847-1911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical