Provider Demographics
NPI:1801253356
Name:LEWIS, SHENIKKA LATARA
Entity type:Individual
Prefix:
First Name:SHENIKKA
Middle Name:LATARA
Last Name:LEWIS
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 1:760 BLUFF ST
Mailing Address - Street 2:#301
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-1680
Mailing Address - Country:US
Mailing Address - Phone:708-407-1166
Mailing Address - Fax:
Practice Address - Street 1:760 BLUFF ST
Practice Address - Street 2:#301
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-1680
Practice Address - Country:US
Practice Address - Phone:708-407-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker