Provider Demographics
NPI:1407270986
Name:LEWIS, AYEESHA (MSCCC-SLP)
Entity Type:Individual
Prefix:
First Name:AYEESHA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 ROME DR APT C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46228-3268
Mailing Address - Country:US
Mailing Address - Phone:281-235-3470
Mailing Address - Fax:
Practice Address - Street 1:2222 ROME DR APT C
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46228-3268
Practice Address - Country:US
Practice Address - Phone:281-235-3470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22005294A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist