Provider Demographics
NPI:1902142490
Name:LOPEZ, LOUISA M (MA, CCC-SLP, TSSLD)
Entity type:Individual
Prefix:
First Name:LOUISA
Middle Name:M
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 NORHURST WAY
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4108
Mailing Address - Country:US
Mailing Address - Phone:516-369-6933
Mailing Address - Fax:
Practice Address - Street 1:604 NORHURST WAY
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4108
Practice Address - Country:US
Practice Address - Phone:516-369-6933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09394235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1689308025OtherNPI
MD889439600Medicaid