Provider Demographics
NPI:1972151991
Name:LOPEZ, YULISA S (SLP- ASSISTANT)
Entity Type:Individual
Prefix:MISS
First Name:YULISA
Middle Name:S
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:SLP- ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WASHINGTON AVE STE 602
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76701-1283
Mailing Address - Country:US
Mailing Address - Phone:254-296-9792
Mailing Address - Fax:
Practice Address - Street 1:900 WASHINGTON AVE STE 602
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-1283
Practice Address - Country:US
Practice Address - Phone:254-296-9792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX412192355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant