Provider Demographics
NPI:1154057438
Name:ALFORD, LEWIS BARTLEY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:BARTLEY
Last Name:ALFORD
Suffix:
Gender:M
Credentials:MS 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:PO BOX 563
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:FL
Mailing Address - Zip Code:32341-0563
Mailing Address - Country:US
Mailing Address - Phone:850-973-7199
Mailing Address - Fax:
Practice Address - Street 1:235 SW DADE ST STE B
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-2363
Practice Address - Country:US
Practice Address - Phone:850-973-7199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4255235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist