Provider Demographics
NPI:1578943080
Name:LEWIS, MARGARET MARY
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARY
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARGARET
Other - Middle Name:MARY
Other - Last Name:LEWIS DILLIARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 SILVER LAKE RD NW
Mailing Address - Street 2:110
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1786
Mailing Address - Country:US
Mailing Address - Phone:651-379-1718
Mailing Address - Fax:651-628-0411
Practice Address - Street 1:3701 12TH STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:218-631-5993
Practice Address - Fax:218-631-7043
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1667106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist