Provider Demographics
NPI:1437674470
Name:LEWANDOWSKI, JESSICA L (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:LEWANDOWSKI
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 1:79 HARLAN AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47932-1738
Mailing Address - Country:US
Mailing Address - Phone:765-585-5329
Mailing Address - Fax:
Practice Address - Street 1:1600 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:IN
Practice Address - Zip Code:47932-1715
Practice Address - Country:US
Practice Address - Phone:765-793-4818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22005776A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty