Provider Demographics
NPI:1831550490
Name:TRUESDELL-LEWIS, ANGELA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:TRUESDELL-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 1:180 JACKSON PLZ
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-1959
Mailing Address - Country:US
Mailing Address - Phone:734-769-0505
Mailing Address - Fax:734-769-0797
Practice Address - Street 1:180 JACKSON PLZ
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-1959
Practice Address - Country:US
Practice Address - Phone:734-769-0505
Practice Address - Fax:734-769-0797
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101004683235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist