Individual provider Active NPI

Amanda Lopez

  • Speech-Language Pathologist
  • Longmont, CO
National Provider Identifier
1043925944
Registry record updated Jan 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SLP.0005036 Issued in CO
Practice address
711 Darby CT Apt 205
Longmont, CO 80501-5076
Phone
(612) 770-1709
NPI assigned
Jan 16, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 16, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SLP.0005036 CO Primary

Addresses

Primary practice location

711 Darby CT Apt 205
Longmont, CO 80501-5076

Mailing address

711 Darby CT Apt 205
Longmont, CO 80501-5076
Phone (612) 770-1709

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240208000730 CO Practitioner - Qualified Speech Language Pathologist 1658714597 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Healthcare Services Inc 3,431 clinicians
Healthpro Heritage Rehab and Fitness LLC 976 clinicians

Practice addresses (Care Compare)

2310 9TH Ave
Longmont, CO 80503-4008
Phone (303) 834-8426

4950 Thunderbird Dr
Boulder, CO 80303-3835
Phone (720) 778-2767

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Healthpro Heritage Rehab & Fitness, LLC Speech-Language Pathologist CurrentSince Oct 25, 2025 Accepting new patients
Legacy Healthcare Services Inc. Speech-Language Pathologist CurrentSince Jan 15, 2024 Accepting new patients
Healthpro Heritage Rehab & Fitness, LLC Speech-Language Pathologist CurrentSince Oct 25, 2025 Accepting new patients
Legacy Healthcare Services Inc Speech-Language Pathologist CurrentSince Jan 15, 2024 Accepting new patients

Locations

4950 Thunderbird Dr
Boulder, CO 80303
Phone (303) 499-4888

110 Horizon Dr
Ste 310
Raleigh, NC 27615
Phone (970) 215-3300

Organizations & group practices 26

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1673827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673827200000",
    "number": "1043925944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 DARBY CT APT 205",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805015076",
            "telephone_number": "612-770-1709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 DARBY CT APT 205",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805015076",
            "telephone_number": "612-770-1709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "AMANDA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-01-16",
        "last_updated": "2023-01-16",
        "certification_date": "2023-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CO",
            "license": "SLP.0005036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longmont, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.