Provider Demographics
NPI:1942967534
Name:LOPEZ, YADIRA JANETH (SLPA)
Entity type:Individual
Prefix:
First Name:YADIRA
Middle Name:JANETH
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 W FOOTHILL BLVD UNIT 38
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-2494
Mailing Address - Country:US
Mailing Address - Phone:626-590-4392
Mailing Address - Fax:
Practice Address - Street 1:627 W FOOTHILL BLVD UNIT 38
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-2494
Practice Address - Country:US
Practice Address - Phone:626-590-4392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32092355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant