Provider Demographics
NPI:1720381460
Name:LEWIS-RAYMAN, KATHY MARIE
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:MARIE
Last Name:LEWIS-RAYMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KATHY
Other - Middle Name:MARIE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1005 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7448
Mailing Address - Country:US
Mailing Address - Phone:541-774-8201
Mailing Address - Fax:
Practice Address - Street 1:1005 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7448
Practice Address - Country:US
Practice Address - Phone:541-774-8201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical