Provider Demographics
NPI:1073149985
Name:LOPEZ-LAM, ANN BETTINA (MS, CCC-SLP, IBCLC)
Entity Type:Individual
Prefix:
First Name:ANN BETTINA
Middle Name:
Last Name:LOPEZ-LAM
Suffix:
Gender:F
Credentials:MS, CCC-SLP, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 NEWMAN SPRINGS ROAD
Mailing Address - Street 2:BUILDING 1, 4TH FLOOR, SUITE 143
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-6767
Mailing Address - Country:US
Mailing Address - Phone:732-234-9944
Mailing Address - Fax:
Practice Address - Street 1:331 NEWMAN SPRINGS RD
Practice Address - Street 2:BUILDING 1, 4TH FLOOR, SUITE 143
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-6767
Practice Address - Country:US
Practice Address - Phone:732-234-9944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-312685174N00000X
NJ41YS00690800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty