Provider Demographics
NPI:1194036988
Name:WESLEY LOPEZ, MEGAN RAE (MAED/CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:RAE
Last Name:WESLEY LOPEZ
Suffix:
Gender:F
Credentials:MAED/CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1070
Mailing Address - Country:US
Mailing Address - Phone:859-358-8424
Mailing Address - Fax:
Practice Address - Street 1:329 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1070
Practice Address - Country:US
Practice Address - Phone:859-358-8424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3492235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist