Provider Demographics
NPI:1821157595
Name:LEWIS, JENNIFER CARTER (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CARTER
Last Name:LEWIS
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 INDIAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:NC
Mailing Address - Zip Code:28365-8775
Mailing Address - Country:US
Mailing Address - Phone:919-658-9571
Mailing Address - Fax:919-658-9571
Practice Address - Street 1:1915 INDIAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MOUNT OLIVE
Practice Address - State:NC
Practice Address - Zip Code:28365-8775
Practice Address - Country:US
Practice Address - Phone:919-658-9571
Practice Address - Fax:919-658-9571
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4197235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411666Medicaid