Provider Demographics
NPI:1083721534
Name:LOPEZ, SANDRA P (LPC)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:P
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:J
Other - Last Name:PRATT-LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-647-6326
Mailing Address - Fax:414-671-8860
Practice Address - Street 1:9200 W LOOMIS RD
Practice Address - Street 2:#217
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8887
Practice Address - Country:US
Practice Address - Phone:414-529-9180
Practice Address - Fax:414-529-9189
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1227-125101YP2500X, 101Y00000X
WI63753-030101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39402200Medicaid