Provider Demographics
NPI:1609934082
Name:LEWIS & CLARK INC
Entity Type:Organization
Organization Name:LEWIS & CLARK INC
Other - Org Name:SPEECH CONNECTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF SPEECH PATHOLOGY & SLP
Authorized Official - Prefix:
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:919-787-4400
Mailing Address - Street 1:6512 SIX FORKS RD
Mailing Address - Street 2:STE 203B
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6561
Mailing Address - Country:US
Mailing Address - Phone:919-787-4400
Mailing Address - Fax:919-341-1020
Practice Address - Street 1:6512 SIX FORKS RD
Practice Address - Street 2:STE 203B
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6561
Practice Address - Country:US
Practice Address - Phone:919-787-4400
Practice Address - Fax:919-341-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2009-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211817Medicaid