Healthcare Provider Details

I. General information

NPI: 1467948265
Provider Name (Legal Business Name): VANESSA LYNN LOPEZ M.S., SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 N ED CAREY DR
HARLINGEN TX
78550-7914
US

IV. Provider business mailing address

4605 N JACKSON RD
MCALLEN TX
78504-6100
US

V. Phone/Fax

Practice location:
  • Phone: 956-440-1155
  • Fax: 956-440-0913
Mailing address:
  • Phone: 956-631-3050
  • Fax: 956-630-4209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number113766
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: