Provider Demographics
NPI:1053676460
Name:LOPEZ, CARALYN M (MS SLP)
Entity type:Individual
Prefix:
First Name:CARALYN
Middle Name:M
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:303 MILLER STREET
Mailing Address - City:ORISKANY
Mailing Address - State:NY
Mailing Address - Zip Code:13424-0003
Mailing Address - Country:US
Mailing Address - Phone:315-527-5276
Mailing Address - Fax:
Practice Address - Street 1:303 MILLER STREET
Practice Address - Street 2:
Practice Address - City:ORISKANY
Practice Address - State:NY
Practice Address - Zip Code:13424-0003
Practice Address - Country:US
Practice Address - Phone:315-527-5276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022003-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist