Provider Demographics
NPI:1831811405
Name:LOPEZ, ALEXIS DANIELA (SLPA)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:DANIELA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5675 W BOPP RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85735-8863
Mailing Address - Country:US
Mailing Address - Phone:520-730-9187
Mailing Address - Fax:
Practice Address - Street 1:5675 W BOPP RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85735-8863
Practice Address - Country:US
Practice Address - Phone:520-730-9187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA137002355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty