Provider Demographics
NPI:1306033097
Name:LEWIS, LISLE TITILOLA (SLPA)
Entity Type:Individual
Prefix:MS
First Name:LISLE
Middle Name:TITILOLA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 CARLTON AVE APT 8F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-2149
Mailing Address - Country:US
Mailing Address - Phone:347-497-2547
Mailing Address - Fax:775-582-3964
Practice Address - Street 1:5130 RIVERSIDE DRIVE
Practice Address - Street 2:CHINO VALLEY UNIFIED SCHOOL DISTRICT
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710
Practice Address - Country:US
Practice Address - Phone:909-628-1201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant