Provider Demographics
NPI:1073161030
Name:LEWIS MOWRY, JESSICA MICHELLE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MICHELLE
Last Name:LEWIS MOWRY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MICHELLE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4407 N DIVISION ST STE 618
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1660
Mailing Address - Country:US
Mailing Address - Phone:509-279-2555
Mailing Address - Fax:509-413-1489
Practice Address - Street 1:4407 N DIVISION ST STE 618
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1660
Practice Address - Country:US
Practice Address - Phone:509-279-2555
Practice Address - Fax:509-413-1489
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60587445235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist