Provider Demographics
NPI:1083898431
Name:LEWIS, SANJENETTA I (MED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SANJENETTA
Middle Name:I
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 E POPLAR ST STE D
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-3401
Mailing Address - Country:US
Mailing Address - Phone:478-227-3187
Mailing Address - Fax:
Practice Address - Street 1:228 E POPLAR ST STE D
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-3401
Practice Address - Country:US
Practice Address - Phone:478-227-3187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004324235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist