Provider Demographics
NPI:1073839031
Name:LEWIS, AIMEE LISA
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:LISA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 BALIGNAC AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLYN
Mailing Address - State:PA
Mailing Address - Zip Code:19094-1803
Mailing Address - Country:US
Mailing Address - Phone:610-476-0730
Mailing Address - Fax:
Practice Address - Street 1:177 BALIGNAC AVE
Practice Address - Street 2:
Practice Address - City:WOODLYN
Practice Address - State:PA
Practice Address - Zip Code:19094-1803
Practice Address - Country:US
Practice Address - Phone:610-746-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency