Provider Demographics
NPI:1598147977
Name:LEWIS, VICTORIA (MA CFY-SLP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MA CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-3248
Mailing Address - Country:US
Mailing Address - Phone:413-475-3340
Mailing Address - Fax:
Practice Address - Street 1:91 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3248
Practice Address - Country:US
Practice Address - Phone:413-475-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program