Provider Demographics
NPI:1740344621
Name:LEWIS, MICHELLE J (CHTP, RM)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:J
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CHTP, RM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 S MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1027
Mailing Address - Country:US
Mailing Address - Phone:708-445-1381
Mailing Address - Fax:
Practice Address - Street 1:829 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1027
Practice Address - Country:US
Practice Address - Phone:708-445-1381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist