Provider Demographics
NPI:1982027371
Name:LEWIS, CHRISTIE (MACCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 DEARBAUGH AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-9245
Mailing Address - Country:US
Mailing Address - Phone:419-738-3422
Mailing Address - Fax:
Practice Address - Street 1:1045 DEARBAUGH AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-9245
Practice Address - Country:US
Practice Address - Phone:419-738-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP. 10584235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist