Provider Demographics
NPI:1821243296
Name:LEWIS, MARILYN LOUISE (M A,, CCC-A, FAAA)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:LOUISE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:M A,, CCC-A, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W 9TH ST APT 803
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-4324
Mailing Address - Country:US
Mailing Address - Phone:213-488-0003
Mailing Address - Fax:
Practice Address - Street 1:600 W 9TH ST APT 803
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-4324
Practice Address - Country:US
Practice Address - Phone:213-488-0003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1264237600000X
CAHA1341237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist