Provider Demographics
NPI:1891204731
Name:LEWIS, PAMELA YVETTE
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:YVETTE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 BLAIR LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1801
Mailing Address - Country:US
Mailing Address - Phone:630-759-6340
Mailing Address - Fax:
Practice Address - Street 1:350 BLAIR LN
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1801
Practice Address - Country:US
Practice Address - Phone:630-759-6340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty