Provider Demographics
NPI:1295725091
Name:LEWIS-RICE, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:LEWIS-RICE
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:PSC 76 BOX 8373
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96319-0084
Mailing Address - Country:US
Mailing Address - Phone:910-473-2827
Mailing Address - Fax:
Practice Address - Street 1:640 VILLAGE PARK DR
Practice Address - Street 2:#201
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3688
Practice Address - Country:US
Practice Address - Phone:000-000-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5502235Z00000X
NY006300-1235Z00000X
NC6756235Z00000X
CT002501235Z00000X
CA22383235Z00000X
WVSLP-2029235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412376Medicaid