Provider Demographics
NPI:1588210702
Name:LEWANDOWSKI, KAYLEE MARIE
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:MARIE
Last Name:LEWANDOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 PACHAPPA HL
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2150
Mailing Address - Country:US
Mailing Address - Phone:909-809-1454
Mailing Address - Fax:
Practice Address - Street 1:19195 US HIGHWAY 18 STE 104
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2562
Practice Address - Country:US
Practice Address - Phone:888-557-1305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician