Provider Demographics
NPI:1770697591
Name:LEWIS, MARVIN JAY (AUD)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:JAY
Last Name:LEWIS
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4807 ROCKSIDE RD
Mailing Address - Street 2:#400
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2192
Mailing Address - Country:US
Mailing Address - Phone:216-642-8228
Mailing Address - Fax:216-642-8229
Practice Address - Street 1:4807 ROCKSIDE RD
Practice Address - Street 2:#400
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2192
Practice Address - Country:US
Practice Address - Phone:216-642-8228
Practice Address - Fax:216-642-8229
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00841231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist