Provider Demographics
NPI:1558743492
Name:LEWIS, KATHRYN HARTMAN (MS, BCBA)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:HARTMAN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 S 33RD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2012
Mailing Address - Country:US
Mailing Address - Phone:203-300-9232
Mailing Address - Fax:
Practice Address - Street 1:1316 S 33RD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2012
Practice Address - Country:US
Practice Address - Phone:203-300-9232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-27
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0124456103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst