Provider Demographics
NPI:1083894620
Name:LEWIS, MICHELLE M (MSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2171 NW DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-4915
Mailing Address - Country:US
Mailing Address - Phone:971-803-9605
Mailing Address - Fax:
Practice Address - Street 1:621 SW ALDER ST STE 520
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3620
Practice Address - Country:US
Practice Address - Phone:503-494-4745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-12
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No372600000XNursing Service Related ProvidersAdult Companion