MEDICARE: MS. SANDRA LOPEZ-GARCIA SLP, CCC/L

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	235Z00000X	Speech-Language Pathologist		IL

General Provider Information

NPI Number	:	1992974513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA LOPEZ-GARCIA SLP, CCC/L

Provider Business Mailing Address
First Line	:	8505 S KOLIN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-3536
Country	:	US
Telephone Number	:	773-767-9585
Fax Number	:

Provider Business Practice Location Address
First Line	:	8505 S KOLIN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-3536
Country	:	US
Telephone Number	:	773-767-9585
Fax Number	:

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

Provider Enumeration Date	:	02/27/2008
Last Update Date	:	02/27/2008

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