Individual
MAYRA LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1547 WADE HAMPTON BLVD, GREENVILLE, SC 29609-5047
(864) 659-0604
Mailing address
1547 WADE HAMPTON BLVD, GREENVILLE, SC 29609-5047
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
6383
SC
Other
Enumeration date
12/10/2020
Last updated
12/10/2020
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