Provider Demographics
NPI:1134566474
Name:LEWANDOWSKI, ASHLEY MAE (MA, CCC-SLP, CBIS)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:MAE
Last Name:LEWANDOWSKI
Suffix:
Gender:F
Credentials:MA, CCC-SLP, CBIS
Other - Prefix:MRS
Other - First Name:ASHLEY
Other - Middle Name:MAE
Other - Last Name:COLDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CF-SLP
Mailing Address - Street 1:812 S GARFIELD AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3456
Mailing Address - Country:US
Mailing Address - Phone:231-421-9201
Mailing Address - Fax:231-421-9193
Practice Address - Street 1:812 S GARFIELD AVE STE 1
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3456
Practice Address - Country:US
Practice Address - Phone:231-421-9201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MIL974111235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist