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1265575278 NPI number — SUSAN MARIE LOPEZ SLP

NPI Number: 1265575278
Health Care Provider/Practitioner: SUSAN MARIE LOPEZ SLP

Information about “1265575278” NPI (SUSAN MARIE LOPEZ SLP) exists in 1265575278 in HTML format HTML  |  1265575278 in plain Text format TXT  |  1265575278 in PDF (Portable Document Format) PDF  |  1265575278 in an XML format XML  formats.

NPI Number : 1265575278 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1265575278",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LOPEZ",
    "FirstName": "SUSAN",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LOPEZ",
    "OtherFirstName": "SUSAN",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "AUD",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "2924 BROOK RD",
    "SecondLineMailingAddress": "CHILDREN'S HOSPITAL CREDENTIALING DEPT",
    "MailingAddressCityName": "RICHMOND",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "23220-1215",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "804-321-7474",
    "MailingAddressFaxNumber": "804-321-2728",
    "FirstLinePracticeLocationAddress": "10530 SPOTSYLVANIA AVE",
    "SecondLinePracticeLocationAddress": "CHILDREN'S HOSPITAL THERAPY CENTER SUITE 102",
    "PracticeLocationAddressCityName": "FREDERICKSBURG",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22408-0000",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "540-891-4485",
    "PracticeLocationAddressFaxNumber": "540-890-4486",
    "EnumerationDate": "02/15/2007",
    "LastUpdateDate": "09/17/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "231H00000X",
          "TaxonomyName": "Audiologist",
          "LicenseNumber": "2201000442",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "2202001904",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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