Provider Demographics
NPI:1558425553
Name:LOPEZ, LETICIA (SLP)
Entity Type:Individual
Prefix:MISS
First Name:LETICIA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 N CONWAY AVE STE F
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2926
Mailing Address - Country:US
Mailing Address - Phone:956-580-4040
Mailing Address - Fax:956-580-4915
Practice Address - Street 1:2002 N CONWAY AVE STE F
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2926
Practice Address - Country:US
Practice Address - Phone:956-580-4040
Practice Address - Fax:956-580-4915
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19633235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist