Provider Demographics
NPI:1588974372
Name:MOUSE LOPEZ, SHARI DAWN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHARI
Middle Name:DAWN
Last Name:MOUSE LOPEZ
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:SHARI
Other - Middle Name:DAWN
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1625 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2848
Mailing Address - Country:US
Mailing Address - Phone:206-388-1300
Mailing Address - Fax:206-328-6871
Practice Address - Street 1:1625 19TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2848
Practice Address - Country:US
Practice Address - Phone:206-388-1300
Practice Address - Fax:206-328-6871
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60184542235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist