Provider Demographics
NPI:1477002574
Name:LOPEZ, AHNALISIA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AHNALISIA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 N COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-7251
Mailing Address - Country:US
Mailing Address - Phone:806-729-2597
Mailing Address - Fax:
Practice Address - Street 1:815 N COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-7251
Practice Address - Country:US
Practice Address - Phone:806-729-2597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106292235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist