Provider Demographics
NPI:1326594391
Name:LEWIS, CHRISTAL LYNN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTAL
Middle Name:LYNN
Last Name:LEWIS
Suffix:
Gender:F
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 324
Mailing Address - Street 2:618 SIMPSON STREET
Mailing Address - City:CISNE
Mailing Address - State:IL
Mailing Address - Zip Code:62823-0324
Mailing Address - Country:US
Mailing Address - Phone:618-839-2474
Mailing Address - Fax:
Practice Address - Street 1:618 SIMPSON STREET
Practice Address - Street 2:
Practice Address - City:CISNE
Practice Address - State:IL
Practice Address - Zip Code:62823-0324
Practice Address - Country:US
Practice Address - Phone:618-839-2474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146011700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist