Provider Demographics
NPI:1942578315
Name:LEWIS, SEMONIQUE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:SEMONIQUE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11914 201ST ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-3810
Mailing Address - Country:US
Mailing Address - Phone:718-413-5418
Mailing Address - Fax:
Practice Address - Street 1:11914 201ST ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-3810
Practice Address - Country:US
Practice Address - Phone:718-415-4418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021500-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist