Provider Demographics
NPI:1366453359
Name:LEWIS, DIANA G (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:G
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 BROADWAY EXT
Mailing Address - Street 2:SUITE 115
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-9045
Mailing Address - Country:US
Mailing Address - Phone:405-840-1335
Mailing Address - Fax:405-840-1336
Practice Address - Street 1:7301 BROADWAY EXT
Practice Address - Street 2:SUITE 115
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-9045
Practice Address - Country:US
Practice Address - Phone:405-840-1335
Practice Address - Fax:405-840-1336
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2009235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist