Provider Demographics
NPI:1568774545
Name:LEWIS, WHITNEY W (SLP)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:W
Last Name:LEWIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2962 GLASS MILL RD
Mailing Address - Street 2:
Mailing Address - City:CHICKAMAUGA
Mailing Address - State:GA
Mailing Address - Zip Code:30707-3474
Mailing Address - Country:US
Mailing Address - Phone:423-667-3401
Mailing Address - Fax:
Practice Address - Street 1:1011 ABUTMENT RD STE 112
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-4660
Practice Address - Country:US
Practice Address - Phone:706-252-8660
Practice Address - Fax:706-841-9211
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007347235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist