Provider Demographics
NPI:1790344604
Name:LEWIS, ANNIE UMA (BS)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:UMA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-4627
Mailing Address - Country:US
Mailing Address - Phone:480-392-0156
Mailing Address - Fax:
Practice Address - Street 1:3850 E BASELINE RD STE 109
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4403
Practice Address - Country:US
Practice Address - Phone:480-818-4212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA116432355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant