Provider Demographics
NPI:1073999579
Name:LEWIS, KELLY M (AUD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:LEWIS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5202 E MAIN ST
Mailing Address - Street 2:SUITE #105
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-8038
Mailing Address - Country:US
Mailing Address - Phone:480-218-1328
Mailing Address - Fax:480-218-1330
Practice Address - Street 1:1625 N 87TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-2922
Practice Address - Country:US
Practice Address - Phone:480-429-0026
Practice Address - Fax:480-429-0028
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA9474231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist