Provider Demographics
NPI:1104211614
Name:LEWAN, RHONDA (MS)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:LEWAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:PHILLIPS
Mailing Address - State:WI
Mailing Address - Zip Code:54555-0071
Mailing Address - Country:US
Mailing Address - Phone:715-339-3048
Mailing Address - Fax:715-339-2436
Practice Address - Street 1:171 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILLIPS
Practice Address - State:WI
Practice Address - Zip Code:54555-1313
Practice Address - Country:US
Practice Address - Phone:715-339-3048
Practice Address - Fax:715-339-2436
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2383101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional