Provider Demographics
NPI:1376204545
Name:LEWIS, LAURA ROBERSON (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ROBERSON
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 1:2 MUIRFIELD CT
Mailing Address - Street 2:
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-5538
Mailing Address - Country:US
Mailing Address - Phone:817-602-0629
Mailing Address - Fax:
Practice Address - Street 1:2001 TEXAN DR
Practice Address - Street 2:
Practice Address - City:JUSTIN
Practice Address - State:TX
Practice Address - Zip Code:76247-8791
Practice Address - Country:US
Practice Address - Phone:817-698-7259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18496235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist