Provider Demographics
NPI:1881148369
Name:LEWIS, ANGELA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:5278 W 10740 N
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-8899
Mailing Address - Country:US
Mailing Address - Phone:801-889-7751
Mailing Address - Fax:801-855-6351
Practice Address - Street 1:5278 W 10740 N
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-8899
Practice Address - Country:US
Practice Address - Phone:801-889-7751
Practice Address - Fax:801-855-6351
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT52061504102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist