Provider Demographics
NPI:1932805785
Name:LOPEZ, CONNIE M (MS, TSHH)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:M
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MS, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 LENOX RD
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-5610
Mailing Address - Country:US
Mailing Address - Phone:646-244-6274
Mailing Address - Fax:
Practice Address - Street 1:9110 146TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-4301
Practice Address - Country:US
Practice Address - Phone:718-468-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist