Provider Demographics
NPI:1356047096
Name:LOPEZ, LINDSEY (M ED)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 RED FERN DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:ID
Mailing Address - Zip Code:83644-5851
Mailing Address - Country:US
Mailing Address - Phone:951-282-0842
Mailing Address - Fax:
Practice Address - Street 1:823 RED FERN DR
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:ID
Practice Address - Zip Code:83644-5851
Practice Address - Country:US
Practice Address - Phone:951-282-0842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist