Provider Demographics
NPI:1003194838
Name:LOPEZ, JEANETTE B (MA; CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:B
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MA; CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 SEPTIEMBRE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-2819
Mailing Address - Country:US
Mailing Address - Phone:915-373-2456
Mailing Address - Fax:
Practice Address - Street 1:1510 N ZARAGOZA RD
Practice Address - Street 2:STE. A-11
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7975
Practice Address - Country:US
Practice Address - Phone:915-855-0601
Practice Address - Fax:915-855-0751
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX10307235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist