Provider Demographics
NPI:1922445543
Name:LOPEZ-ADDISON, BELEN (SLP)
Entity Type:Individual
Prefix:
First Name:BELEN
Middle Name:
Last Name:LOPEZ-ADDISON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:BELEN
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3901 HOUMA BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2930
Mailing Address - Country:US
Mailing Address - Phone:504-784-8840
Mailing Address - Fax:504-218-5317
Practice Address - Street 1:3901 HOUMA BLVD STE 108
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2930
Practice Address - Country:US
Practice Address - Phone:504-784-8840
Practice Address - Fax:504-218-5317
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM103K00000X
NMC-5523235Z00000X
LA7622235Z00000X
LA7612235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2439821Medicaid