Provider Demographics
NPI:1003129883
Name:LEWIS, JENNIFER ALVA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ALVA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:DEA
Other - Last Name:ALVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:855 E RIVER RD
Mailing Address - Street 2:#152
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5648
Mailing Address - Country:US
Mailing Address - Phone:520-396-8046
Mailing Address - Fax:
Practice Address - Street 1:6700 N ORACLE RD
Practice Address - Street 2:STE 411
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7732
Practice Address - Country:US
Practice Address - Phone:520-829-9635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP6803235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist