Provider Demographics
NPI:1093287088
Name:LEWIS, KATHERINE JEAN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:JEAN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13117 WILLIAMS RD SE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7964
Mailing Address - Country:US
Mailing Address - Phone:240-580-4408
Mailing Address - Fax:
Practice Address - Street 1:11001 FOREST AVE NE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-8152
Practice Address - Country:US
Practice Address - Phone:301-724-3285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06009235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist