Provider Demographics
NPI:1487953824
Name:LOPEZ, ALEXIS N (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:N
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9093 RIDGEFIELD DR.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-6711
Mailing Address - Country:US
Mailing Address - Phone:301-846-4769
Mailing Address - Fax:301-846-0059
Practice Address - Street 1:9093 RIDGEFIELD DR.
Practice Address - Street 2:SUITE 102
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6711
Practice Address - Country:US
Practice Address - Phone:301-846-4769
Practice Address - Fax:301-846-0059
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06351235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist