Provider Demographics
NPI:1598897621
Name:LEWARK, NANCY MARIE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:MARIE
Last Name:LEWARK
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 S STATE ROAD 135
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-9607
Mailing Address - Country:US
Mailing Address - Phone:317-535-4075
Mailing Address - Fax:317-535-4076
Practice Address - Street 1:3000 S STATE ROAD 135
Practice Address - Street 2:SUITE 110
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-9607
Practice Address - Country:US
Practice Address - Phone:317-535-4075
Practice Address - Fax:317-535-4076
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22001138A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200644490Medicaid