Healthcare Provider Details

I. General information

NPI: 1265575278
Provider Name (Legal Business Name): SUSAN MARIE LOPEZ SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN MARIE LOPEZ AUD

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10530 SPOTSYLVANIA AVE CHILDREN'S HOSPITAL THERAPY CENTER SUITE 102
FREDERICKSBURG VA
22408-0000
US

IV. Provider business mailing address

2924 BROOK RD CHILDREN'S HOSPITAL CREDENTIALING DEPT
RICHMOND VA
23220-1215
US

V. Phone/Fax

Practice location:
  • Phone: 540-891-4485
  • Fax: 540-890-4486
Mailing address:
  • Phone: 804-321-7474
  • Fax: 804-321-2728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201000442
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202001904
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: