Provider Demographics
NPI:1659406437
Name:LOPEZ REISS, JULIE ELIZABETH (MACCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ELIZABETH
Last Name:LOPEZ REISS
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 DRURY LN
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-9742
Mailing Address - Country:US
Mailing Address - Phone:413-529-9399
Mailing Address - Fax:
Practice Address - Street 1:1 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-1672
Practice Address - Country:US
Practice Address - Phone:413-527-2711
Practice Address - Fax:413-529-9715
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4041235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist