Provider Demographics
NPI:1750027686
Name:LEWIS, ROBIN
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:SOUTHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19202 CORBYN LN
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64089-9719
Mailing Address - Country:US
Mailing Address - Phone:816-574-1999
Mailing Address - Fax:
Practice Address - Street 1:10502 N AMBASSADOR DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64153-1278
Practice Address - Country:US
Practice Address - Phone:816-608-1951
Practice Address - Fax:800-687-5070
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No175T00000XOther Service ProvidersPeer Specialist