Provider Demographics
NPI:1083490320
Name:LEWIS, GAYLE (LSW)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:GAYLE
Other - Middle Name:
Other - Last Name:SILAGYI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:313 N MATTIS AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-7900
Mailing Address - Country:US
Mailing Address - Phone:224-232-8057
Mailing Address - Fax:
Practice Address - Street 1:313 N MATTIS AVE STE 116
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-7900
Practice Address - Country:US
Practice Address - Phone:224-232-8057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
150.111075104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker