MEDICARE: SUSAN MARIE LOPEZ SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	2201000442	VA
2	235Z00000X	Speech-Language Pathologist	2202001904	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265575278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MARIE LOPEZ SLP

Provider Business Mailing Address
First Line	:	2924 BROOK RD
Second Line	:	CHILDREN'S HOSPITAL CREDENTIALING DEPT
City	:	RICHMOND
State	:	VA
Zip	:	23220-1215
Country	:	US
Telephone Number	:	804-321-7474
Fax Number	:	804-321-2728

Provider Business Practice Location Address
First Line	:	10530 SPOTSYLVANIA AVE
Second Line	:	CHILDREN'S HOSPITAL THERAPY CENTER SUITE 102
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22408-0000
Country	:	US
Telephone Number	:	540-891-4485
Fax Number	:	540-890-4486

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	09/17/2025

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