Provider Demographics
NPI:1891089439
Name:LOPEZ, GENEVA (MA CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:GENEVA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8018 CHESTNUT BARR DR
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-3351
Mailing Address - Country:US
Mailing Address - Phone:210-669-3605
Mailing Address - Fax:
Practice Address - Street 1:1248 AUSTIN HWY STE 210
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-4867
Practice Address - Country:US
Practice Address - Phone:210-646-8008
Practice Address - Fax:210-646-8242
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19983235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist