Provider Demographics
NPI:1922576172
Name:LEWIS, ASHLEY ELAINAH
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ELAINAH
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:PO BOX 639561
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9561
Mailing Address - Country:US
Mailing Address - Phone:844-247-7222
Mailing Address - Fax:847-584-2604
Practice Address - Street 1:3207 LOUISE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-3020
Practice Address - Country:US
Practice Address - Phone:815-621-0497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-22-58073103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst