Provider Demographics
NPI:1669195913
Name:LOPEZ, MONICA JANE (BSC)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:JANE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 N 17TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-6116
Mailing Address - Country:US
Mailing Address - Phone:480-251-2292
Mailing Address - Fax:
Practice Address - Street 1:1 W ELLIOT RD STE 109
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1310
Practice Address - Country:US
Practice Address - Phone:480-374-4341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA100942355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant