Provider Demographics
NPI:1821785874
Name:LEWIS, CHANCELLOR NOAH (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:CHANCELLOR
Middle Name:NOAH
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 JANE BRIGGS AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-4503
Mailing Address - Country:US
Mailing Address - Phone:859-229-0105
Mailing Address - Fax:
Practice Address - Street 1:400 FARRIS PARKS BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-7650
Practice Address - Country:US
Practice Address - Phone:859-353-3666
Practice Address - Fax:859-448-7077
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY277588235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist